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Di Benedetto F, Magistri P, Marcon F, Soubrane O, Pedreira Mello F, Santos Coelho J, Fernandez AR, Frassoni S, Bagnardi V, Singhal A, Rotellar F, Hernandez-Alejandro R, Alikhanov R, de Souza M Fernandes E, Cauchy F, Muiesan P, Di Sandro S, Pinto Marques H. Vena cava replacement and major hepatectomy for liver tumors: international multicenter retrospective cohort study. Int J Surg 2024:01279778-990000000-01335. [PMID: 38608195 DOI: 10.1097/js9.0000000000001386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/11/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Involvement of the inferior vena cava (IVC) and hepatic veins (HV) has been considered a relative contraindication to hepatic resection for primary and metastatic liver tumors. However, patients affected by tumors extending to the IVC have limited therapeutic options and suffer worsening of quality of life due to IVC compression. METHODS Cases of primary and metastatic liver tumors with vena cava infiltration from 10 international centers were collected (7 European, 1 US, 2 Brazilian, 1 Indian) were collected. Inclusion criteria for the study were major liver resection with concomitant vena cava replacement. Clinical data and short-term outcomes were analyzed. RESULTS 36 cases were finally included in the study. Median tumor max size was 98 mm (range: 25-250). A biliary reconstruction was necessary in 28% of cases, while a vascular reconstruction other than vena cava in 34% of cases. Median operative time was 462 min (range: 230-750), with 750 median ml of estimated blood loss and a median of one pRBC transfused intraoperatively (range: 0-27). Median ICU stay was 4 days (range: 1-30) with overall in-hospital stay of 15 days (range: 3-46), post-operative CCI score of 20.9 (range: 0-100), 12% incidence of PHLF grade B-C. Five patients died in a 90-days interval from surgery, 1 due to heart failure, 1 due to septic shock and 3 due to multiorgan failure. With a median follow-up of 17 months (interquartile range: 11-37), the estimated five-years overall survival was 48% (95% CI: 27%-66%), and five-year cumulative incidence of tumor recurrence was 55% (95% CI: 33%-73%). CONCLUSIONS Major liver resections with vena cava replacement can be performed with satisfactory results in expert HPB centers. This surgical strategy represents a feasible alternative for otherwise unresectable lesions and is associated with favorable prognosis compared to non-operative management, especially in patients affected by intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Fabrizio Di Benedetto
- Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Magistri
- Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Marcon
- HPB Surgery and Liver Transplant, Queen Elizabeth Hospital, Birmingham, UK
| | - Olivier Soubrane
- Department of HPB and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Felipe Pedreira Mello
- Department of Surgery and abdominal organ transplantation - Hospital Adventista Silvestre, Rio de Janeiro, Brazil
| | - Joao Santos Coelho
- Hepato-Biliary-Pancreatic and Transplantation Center, Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Andre Renaldo Fernandez
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Ashish Singhal
- Advanced Institute of Liver & Biliary Sciences, Fortis Hospitals, Delhi, NCR, India
| | - Fernando Rotellar
- HPB and Liver Transplantation Unit, Department of Surgery, University Clinic, Universidad de Navarra; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Roberto Hernandez-Alejandro
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Ruslan Alikhanov
- Department of Hepato-Pancreato-Biliary Surgery and Department of Transplantation, Moscow Clinical Scientific Center, Moscow, Russia
| | - Eduardo de Souza M Fernandes
- Department of Surgery and abdominal organ transplantation - Hospital Adventista Silvestre, Rio de Janeiro, Brazil
- Hepato-pancreato-biliary Unit and Transplant - DHR Health, McAllen, Texas, USA
| | - Francois Cauchy
- Department of HPB and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Paolo Muiesan
- HPB Surgery and Liver Transplant, Queen Elizabeth Hospital, Birmingham, UK
| | - Stefano Di Sandro
- Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Hugo Pinto Marques
- Hepato-Biliary-Pancreatic and Transplantation Center, Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
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Faure A, Dioguardi Burgio M, Cannella R, Sartoris R, Bouattour M, Hobeika C, Cauchy F, Trapani L, Beaufrère A, Vilgrain V, Ronot M. Imaging and prognostic characterization of fat-containing hepatocellular carcinoma subtypes. Radiol Med 2024:10.1007/s11547-024-01807-w. [PMID: 38512627 DOI: 10.1007/s11547-024-01807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Steatohepatitic hepatocellular carcinoma (SH-HCC) is characterized by intratumoral fat with > 50% inflammatory changes. However, intratumoral fat (with or without inflammation) can also be found in not-otherwise specified HCC (NOS-HCC). We compared the imaging features and outcome of resected HCC containing fat on pathology including SH-HCC (> 50% steatohepatitic component), NOS-HCC with < 50% steatohepatitic component (SH-NOS-HCC), and fatty NOS-HCC (no steatohepatitic component). MATERIAL AND METHODS From September 2012 to June 2021, 94 patients underwent hepatic resection for fat-containing HCC on pathology. Imaging features and categories were assessed using LIRADS v2018. Fat quantification was performed on chemical-shift MRI. Recurrence-free and overall survival were estimated. RESULTS Twenty-one patients (26%) had nonalcoholic steatohepatitis (NASH). The median intra-tumoral fat fraction was 8%, with differences between SH-HCC and SH-NOS-HCC (9.5% vs. 5% p = 0.03). There was no difference in major LI-RADS features between all groups; most tumors were classified as LR-4/5. A mosaic architecture on MRI was rare (7%) in SH-HCC, a fat in mass on CT was more frequently depicted (48%) in SH-HCC. A combination of NASH with no mosaic architecture on MRI or NASH with fat in mass on CT yielded excellent specificity for diagnosing SH-HCC (97.6% and 97.7%, respectively). The median recurrence-free and overall survival were 58 and 87 months, with no difference between groups (p = 0.18 and p = 0.69). CONCLUSION In patients with NASH, an SH-HCC may be suspected in L4/LR-5 observations with no mosaic architecture at MRI or with fat in mass on CT. Oncological outcomes appear similar between fat-containing HCC subtypes.
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Affiliation(s)
- Alexandre Faure
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
- UMR1149, Centre de Recherche Sur L'inflammation, Université Paris Cité, 75018, Paris, France.
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Riccardo Sartoris
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Mohamed Bouattour
- Department of Digestive Oncology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Christian Hobeika
- Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, AP-HP, 92110, Clichy, France
| | - Francois Cauchy
- Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, AP-HP, 92110, Clichy, France
| | - Loïc Trapani
- Department of Pathology, FHU MOSAIC, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Aurélie Beaufrère
- UMR1149, Centre de Recherche Sur L'inflammation, Université Paris Cité, 75018, Paris, France
- Department of Pathology, FHU MOSAIC, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- UMR1149, Centre de Recherche Sur L'inflammation, Université Paris Cité, 75018, Paris, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- UMR1149, Centre de Recherche Sur L'inflammation, Université Paris Cité, 75018, Paris, France
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Moazzam Z, Alaimo L, Endo Y, Lima HA, Woldesenbet S, Rueda BO, Yang J, Ratti F, Marques HP, Cauchy F, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Martel G, Guglielmi A, Hugh T, Aldrighetti L, Shen F, Endo I, Pawlik TM. A Prognostic Model To Predict Survival After Recurrence Among Patients With Recurrent Hepatocellular Carcinoma. Ann Surg 2024; 279:471-478. [PMID: 37522251 DOI: 10.1097/sla.0000000000006056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVE We sought to develop and validate a preoperative model to predict survival after recurrence (SAR) in hepatocellular carcinoma (HCC). BACKGROUND Although HCC is characterized by recurrence as high as 60%, models to predict outcomes after recurrence remain relatively unexplored. METHODS Patients who developed recurrent HCC between 2000 and 2020 were identified from an international multi-institutional database. Clinicopathologic data on primary disease and laboratory and radiologic imaging data on recurrent disease were collected. Multivariable Cox regression analysis and internal bootstrap validation (5000 repetitions) were used to develop and validate the SARScore. Optimal Survival Tree analysis was used to characterize SAR among patients treated with various treatment modalities. RESULTS Among 497 patients who developed recurrent HCC, median SAR was 41.2 months (95% CI 38.1-52.0). The presence of cirrhosis, number of primary tumors, primary macrovascular invasion, primary R1 resection margin, AFP>400 ng/mL on the diagnosis of recurrent disease, radiologic extrahepatic recurrence, radiologic size and number of recurrent lesions, radiologic recurrent bilobar disease, and early recurrence (≤24 months) were included in the model. The SARScore successfully stratified 1-, 3- and 5-year SAR and demonstrated strong discriminatory ability (3-year AUC: 0.75, 95% CI 0.70-0.79). While a subset of patients benefitted from resection/ablation, Optimal Survival Tree analysis revealed that patients with high SARScore disease had the worst outcomes (5-year AUC; training: 0.79 vs. testing: 0.71). The SARScore model was made available online for ease of use and clinical applicability ( https://yutaka-endo.shinyapps.io/SARScore/ ). CONCLUSION The SARScore demonstrated strong discriminatory ability and may be a clinically useful tool to help stratify risk and guide treatment for patients with recurrent HCC.
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Affiliation(s)
- Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
- Department of Surgery, University of Verona, Verona, Italy
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Belisario Ortiz Rueda
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Jason Yang
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Francois Cauchy
- Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | | | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | | | - Tom Hugh
- Department of Surgery, School of Medicine, The University of Sydney, Sydney, NSW, Australia
| | | | - Feng Shen
- The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Itaru Endo
- Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
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Cannella R, Santinha J, Bèaufrere A, Ronot M, Sartoris R, Cauchy F, Bouattour M, Matos C, Papanikolaou N, Vilgrain V, Dioguardi Burgio M. Performances and variability of CT radiomics for the prediction of microvascular invasion and survival in patients with HCC: a matter of chance or standardisation? Eur Radiol 2023; 33:7618-7628. [PMID: 37338558 DOI: 10.1007/s00330-023-09852-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/28/2023] [Accepted: 04/21/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To measure the performance and variability of a radiomics-based model for the prediction of microvascular invasion (MVI) and survival in patients with resected hepatocellular carcinoma (HCC), simulating its sequential development and application. METHODS This study included 230 patients with 242 surgically resected HCCs who underwent preoperative CT, of which 73/230 (31.7%) were scanned in external centres. The study cohort was split into training set (158 patients, 165 HCCs) and held-out test set (72 patients, 77 HCCs), stratified by random partitioning, which was repeated 100 times, and by a temporal partitioning to simulate the sequential development and clinical use of the radiomics model. A machine learning model for the prediction of MVI was developed with least absolute shrinkage and selection operator (LASSO). The concordance index (C-index) was used to assess the value to predict the recurrence-free (RFS) and overall survivals (OS). RESULTS In the 100-repetition random partitioning cohorts, the radiomics model demonstrated a mean AUC of 0.54 (range 0.44-0.68) for the prediction of MVI, mean C-index of 0.59 (range 0.44-0.73) for RFS, and 0.65 (range 0.46-0.86) for OS in the held-out test set. In the temporal partitioning cohort, the radiomics model yielded an AUC of 0.50 for the prediction of MVI, a C-index of 0.61 for RFS, and 0.61 for OS, in the held-out test set. CONCLUSIONS The radiomics models had a poor performance for the prediction of MVI with a large variability in the model performance depending on the random partitioning. Radiomics models demonstrated good performance in the prediction of patient outcomes. CLINICAL RELEVANCE STATEMENT Patient selection within the training set strongly influenced the performance of the radiomics models for predicting microvascular invasion; therefore, a random approach to partitioning a retrospective cohort into a training set and a held-out set seems inappropriate. KEY POINTS • The performance of the radiomics models for the prediction of microvascular invasion and survival widely ranged (AUC range 0.44-0.68) in the randomly partitioned cohorts. • The radiomics model for the prediction of microvascular invasion was unsatisfying when trying to simulate its sequential development and clinical use in a temporal partitioned cohort imaged with a variety of CT scanners. • The performance of the radiomics models for the prediction of survival was good with similar performances in the 100-repetition random partitioning and temporal partitioning cohorts.
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Affiliation(s)
- Roberto Cannella
- Department of Radiology, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- Section of Radiology-BiND, University Hospital 'Paolo Giaccone', Palermo, Italy
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Joao Santinha
- Champalimaud Foundation-Centre for the Unknown, 1400-038, Lisbon, Portugal
| | | | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- Université de Paris, INSERM U1149 'centre de recherche sur l'inflammation', CRI, Paris, France
| | - Riccardo Sartoris
- Department of Radiology, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- Université de Paris, INSERM U1149 'centre de recherche sur l'inflammation', CRI, Paris, France
| | - Francois Cauchy
- Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | | | - Celso Matos
- Champalimaud Foundation-Centre for the Unknown, 1400-038, Lisbon, Portugal
| | | | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- Université de Paris, INSERM U1149 'centre de recherche sur l'inflammation', CRI, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
- Université de Paris, INSERM U1149 'centre de recherche sur l'inflammation', CRI, Paris, France.
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Brustia R, Bouattour M, Allaire M, Lequoy M, Hollande C, Regnault H, Blaise L, Ganne-Carrié N, Vilgrain V, Larrey E, Lim C, Scatton O, Mouhadi SE, Ozenne V, Paye F, Balladur P, Dohan A, Massault PP, Pol S, Dioguardi Burgio M, Sepulveda A, Cauchy F, Luciani A, Sommacale D, Leroy V, Calderaro J, Roudot-Thoraval F, Nault JC, Amaddeo G. Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area: What's new 12 months later? Ann Hepatol 2023; 28:101141. [PMID: 37468096 DOI: 10.1016/j.aohep.2023.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES The lockdown policy introduced in 2020 to minimize the spread of the COVID-19 pandemic, significantly affected the management and care of patients affected by hepatocellular carcinoma (HCC). The aim of this follow-up study was to determine the 12 months impact of the COVID-19 pandemic on the cohort of patients affected by HCC during the lockdown, within six French academic referral centers in the metropolitan area of Paris. MATERIALS AND METHODS We performed a 12 months follow-up of the cross-sectional study cohort included in 2020 on the management of patients affected by HCC during the first six weeks of the COVID-19 pandemic (exposed), compared to the same period in 2019 (unexposed). Overall survival were compared between the groups. Predictors of mortality were analysed with Cox regression. RESULTS From the initial cohort, 575 patients were included (n = 263 Exposed_COVID, n = 312 Unexposed_COVID). Overall and disease free survival at 12 months were 59.9 ± 3.2% vs 74.3 ± 2.5% (p<0.001) and 40.2 ± 3.5% vs 63.5 ± 3.1% (p<0.001) according to the period of exposure (Exposed_COVID vs Unexposed_COVID, respectively). Adjusted Cox regression revealed that the period of exposure (Exposed_COVID HR: 1.79, 95%CI (1.36, 2.35) p<0.001) and BCLC stage B, C and D (BCLC B HR: 1.82, 95%CI (1.07, 3.08) p = 0.027 - BCLC C HR: 1.96, 95%CI (1.14, 3.38) p = 0.015 - BCLC D HR: 3.21, 95%CI (1.76, 5.85) p<0.001) were predictors of death. CONCLUSIONS Disruption of routine healthcare services because of the pandemic translated to reduced 1 year overall and disease-free survival among patients affected by HCC, in the metropolitan area of Paris, France.
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Affiliation(s)
- Raffaele Brustia
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France.
| | - Mohamed Bouattour
- Département d'Oncologie Hépatique, AP-HP, Hôpital Beaujon, F-92110 Clichy, France
| | - Manon Allaire
- Sorbonne Université, Paris, France; Hepatology and Liver transplantation department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France
| | - Marie Lequoy
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - Clémence Hollande
- Department of Hepatology, AP-HP, Hôpital Cochin, F-75014 Paris, France
| | - Hélène Regnault
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Lorraine Blaise
- Service d'hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Nathalie Ganne-Carrié
- Service d'hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France - INSERM U1149 "centre de recherche sur l'inflammation", CRI, Paris France
| | - Edouard Larrey
- Sorbonne Université, Paris, France; Hepatology and Liver transplantation department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France
| | - Chetana Lim
- Digestive and Liver transplantation department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France
| | - Olivier Scatton
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France; Digestive and Liver transplantation department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France
| | - Sanaa El Mouhadi
- Department of Radiology, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - Violaine Ozenne
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - François Paye
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - Pierre Balladur
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - Anthony Dohan
- Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
| | - Pierre-Philippe Massault
- Department of Digestive Surgery, AP-HP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
| | - Stanislas Pol
- Department of Hepatology, AP-HP, Hôpital Cochin, F-75014 Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France - INSERM U1149 "centre de recherche sur l'inflammation", CRI, Paris France
| | - Ailton Sepulveda
- Digestive and Liver transplantation department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Francois Cauchy
- Digestive and Liver transplantation department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Alain Luciani
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France; Department of Radiology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; Paris Est Créteil University, UPEC, Créteil, France
| | - Daniele Sommacale
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France; Paris Est Créteil University, UPEC, Créteil, France
| | - Vincent Leroy
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France; Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; Paris Est Créteil University, UPEC, Créteil, France
| | - Julien Calderaro
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France; Inserm, U955, Team 18, Créteil, France; European Reference Network (ERN) RARE-LIVER, France
| | | | - Jean-Charles Nault
- Service d'hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France
| | - Giuliana Amaddeo
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France; Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; Paris Est Créteil University, UPEC, Créteil, France.
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Previtali C, Sartoris R, Rebours V, Couvelard A, Cros J, Sauvanet A, Cauchy F, Paradis V, Vilgrain V, Dioguardi Burgio M, Ronot M. Quantitative imaging predicts pancreatic fatty infiltration on routine CT examination. Diagn Interv Imaging 2023; 104:359-367. [PMID: 37061392 DOI: 10.1016/j.diii.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE The purpose of this study was to assess the performance of quantitative computed tomography (CT) imaging for detecting pancreatic fatty infiltration, using the results of histopathological analysis as reference. MATERIALS AND METHODS Sixty patients who underwent pancreatic surgery for a pancreatic tumor between 2016 and 2019 were retrospectively included. There were 33 women and 27 men with a mean age of 56 ± 12 (SD) years (age range: 18-79 years). Patients with dilatation of the main pancreatic duct, chronic pancreatitis, or preoperative treatment were excluded to prevent any bias in the radiological-pathological correlation. Pancreatic fatty infiltration was recorded at pathology. Pancreatic surface lobularity, pancreatic attenuation, visceral fat area, and subcutaneous fat area were derived from preoperative CT images. The performance for the prediction of fatty infiltration was assessed using area under receiver operating characteristic curve (AUC) and backward binary logistic regression analysis. Results were validated in a separate cohort of 34 patients (17 women; mean age, 50 ± 14 [SD] years; age range: 18-73). RESULTS A total of 28/60 (47%) and 17/34 (50%) patients had pancreatic fatty infiltration in the derivation and validation cohorts, respectively. In the derivation cohort, patients with pancreatic fatty infiltration had a significantly higher PSL (P < 0.001) and a lower pancreatic attenuation on both precontrast and portal venous phase images (P = 0.011 and 0.003, respectively), and higher subcutaneous fat area and visceral fat area (P = 0.010 and 0.007, respectively). Multivariable analysis identified pancreatic surface lobularity > 7.6 and pancreatic attenuation on portal venous phase images < 83.5 Hounsfield units as independently associated with fatty infiltration. The combination of these variables resulted in an AUC of 0.85 (95% CI: 0.74-0.95) and 0.83 (95% CI: 0.67-0.99) in the derivation and validation cohorts, respectively. CONCLUSION CT-based quantitative imaging accurately predicts pancreatic fatty infiltration.
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Affiliation(s)
- Clelia Previtali
- Department of Radiology. APHP.Nord. Beaujon Hospital, 92118 Clichy, France
| | - Riccardo Sartoris
- Department of Radiology. APHP.Nord. Beaujon Hospital, 92118 Clichy, France; Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Vinciane Rebours
- Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France; Department of Pancreatology. APHP.Nord. Beaujon Hospital, 92118 Clichy, France
| | - Anne Couvelard
- Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France; Department of Pathology. APHP.Nord. Bichat Hospital, 75018 Paris, France
| | - Jerome Cros
- Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France; Department of Pathology. APHP.Nord. Beaujon Hospital, 92118 Clichy, France
| | - Alain Sauvanet
- Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France; Department of Hepatobiliary Surgery. APHP.Nord. Beaujon Hospital, 92118 Clichy, France
| | - Francois Cauchy
- Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France; Department of Hepatobiliary Surgery. APHP.Nord. Beaujon Hospital, 92118 Clichy, France
| | - Valérie Paradis
- Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France; Department of Pathology. APHP.Nord. Bichat Hospital, 75018 Paris, France
| | - Valérie Vilgrain
- Department of Radiology. APHP.Nord. Beaujon Hospital, 92118 Clichy, France; Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology. APHP.Nord. Beaujon Hospital, 92118 Clichy, France; Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Maxime Ronot
- Department of Radiology. APHP.Nord. Beaujon Hospital, 92118 Clichy, France; Universit éParis Cité, Centre de Recherche sur l'Inflammation, Inserm, U1149, 75006, Paris, France.
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Pravisani R, Sepulveda A, Cocchi L, de Mello E, Cauchy F, Dokmak S, Farges O, Durand F, Weiss E, Dondero F, Lesurtel M. Reply: Aberrant arteries-1 may be better than 2 for the liver, but maybe not the bile duct. Liver Transpl 2023; 29:E18-E19. [PMID: 36943101 DOI: 10.1097/lvt.0000000000000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Riccardo Pravisani
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
- Liver-Kidney Transplant Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Ailton Sepulveda
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Lorenzo Cocchi
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Estrella de Mello
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Francois Cauchy
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Olivier Farges
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Francois Durand
- Hepatology and Liver Intensive Care, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Federica Dondero
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
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Pravisani R, Sepulveda A, Cocchi L, de Mello E, Cauchy F, Dokmak S, Farges O, Durand F, Weiss E, Dondero F, Lesurtel M. Graft aberrant hepatic arteries in deceased donor liver transplantation: The "one liver, one artery" approach. Liver Transpl 2022; 28:1876-1887. [PMID: 35751148 DOI: 10.1002/lt.26536] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 01/13/2023]
Abstract
In liver transplantation (LT), graft aberrant hepatic arteries (aHAs) frequently require complex arterial reconstructions, potentially increasing the risk of post-operative complications. However, intrahepatic hilar arterial shunts are physiologically present and may allow selective aHA ligation. Thus, we performed a retrospective study from a single-center cohort of 618 deceased donor LTs where a selective reconstruction policy of aHAs was prospectively applied. In the presence of any aHA, the vessel with the largest caliber was first reconstructed. In case of adequate bilobar arterial perfusion assessed on intraparenchymal Doppler ultrasound, the remnant vessel was ligated; otherwise, it was reconstructed. Consequently, outcomes of three patient groups were compared: the "no aHAs" group (n = 499), the "reconstructed aHA" group (n = 25), and the "ligated aHA" group (n = 94). Primary endpoint was rate of biliary complications. Only 38.4% of right aHAs and 3.1% of left aHAs were reconstructed. Rates of biliary complications in the no aHA, reconstructed aHA, and ligated aHA groups were 23.4%, 28%, and 20.2% (p = 0.667), respectively. The prevalence rates of primary non-function (p = 0.534), early allograft dysfunction (p = 0.832), and arterial complications (p = 0.271), as well as patient survival (p = 0.266) were comparable among the three groups. Retransplantation rates were 3.8%, 4%, and 5.3% (p = 0.685), respectively. In conclusion, a selective reconstruction policy of aHAs based on Doppler assessment of bilobar intraparenchymal arterial flow did not increase post-operative morbidity and avoided unnecessary and complex arterial reconstructions.
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Affiliation(s)
- Riccardo Pravisani
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
- Liver-Kidney Transplant Unit, Department of MedicineUniversity of UdineUdineItaly
| | - Ailton Sepulveda
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Lorenzo Cocchi
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Estrella de Mello
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Francois Cauchy
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Olivier Farges
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Francois Durand
- Hepatology and Liver Intensive Care, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Federica Dondero
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Mickaël Lesurtel
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
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Cauchy F, Rode A, Laurent A, Barbier L, Lim C, Schwarz L, Aubé C, Soubrane O, Seror O, Nault JC. A tailored approach for the treatment of hepatocellular carcinoma within Milan criteria developed on advanced fibrosis/cirrhosis by multibipolar radiofrequency ablation or liver resection. Int J Surg 2022. [DOI: 10.1016/j.ijsu.2022.106388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tzedakis S, Cauchy F, Soubrane O. Extended left hepatectomy with inferior vena cava reconstruction and veno-venous bypass for alveolar echinococcosis (with video). J Visc Surg 2022; 159:249-251. [DOI: 10.1016/j.jviscsurg.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cannella R, Dioguardi Burgio M, Beaufrère A, Trapani L, Paradis V, Hobeika C, Cauchy F, Bouattour M, Vilgrain V, Sartoris R, Ronot M. Imaging features of histological subtypes of hepatocellular carcinoma: Implication for LI-RADS. JHEP Rep 2021; 3:100380. [PMID: 34825155 PMCID: PMC8603197 DOI: 10.1016/j.jhepr.2021.100380] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 02/08/2023]
Abstract
Background & Aims The histopathological subtypes of hepatocellular carcinoma (HCC) are associated with distinct clinical features and prognoses. This study aims to report Liver Imaging Reporting and Data System (LI-RADS)-defined imaging features of different HCC subtypes in a cohort of resected tumours and to assess the influence of HCC subtypes on computed tomography (CT)/magnetic resonance imaging (MRI) LI-RADS categorisation in the subgroup of high-risk patients. Methods This retrospective institutional review board-approved study included patients with resected HCCs and available histopathological classification. Three radiologists independently reviewed preoperative CT and MRI exams. The readers evaluated the presence of imaging features according to LI-RADS v2018 definitions and provided a LI-RADS category in patients at high risk of HCC. Differences in LI-RADS features and categorisations were assessed for not otherwise specified (NOS-HCC), steatohepatitic (SH-HCC), and macrotrabecular-massive (MTM-HCC) types of HCCs. Results Two hundred and seventy-seven patients (median age 64.0 years, 215 [77.6%] men) were analysed, which involved 295 HCCs. There were 197 (66.7%) NOS-HCCs, 62 (21.0%) SH-HCCs, 23 (7.8%) MTM-HCCs, and 13 (4.5%) other rare subtypes. The following features were more frequent in MTM-HCC: elevated α-foetoprotein serum levels (p <0.001), tumour-in-vein (p <0.001 on CT, p ≤0.052 on MRI), presence of at least 1 LR-M feature (p ≤0.010 on CT), infiltrative appearance (p ≤0.032 on CT), necrosis or severe ischaemia (p ≤0.038 on CT), and larger size (p ≤0.006 on CT, p ≤0.011 on MRI). SH-HCC was associated with fat in mass (p <0.001 on CT, p ≤0.002 on MRI). The distribution of the LI-RADS major features and categories in high-risk patients did not significantly differ among the 3 main HCC subtypes. Conclusions The distribution of LI-RADS major features and categories is not different among the HCC subtypes. Nevertheless, careful analysis of tumour-in-vein, LR-M, and ancillary features as well as clinico-biological data can provide information for the non-invasive diagnosis of HCC subtypes. Lay summary In high-risk patients, the overall distribution of LI-RADS major features and categories is not different among the histological subtypes of hepatocellular carcinoma, but tumour-in-vein, presence of LR-M features, and ancillary features can provide information for the non-invasive diagnosis of hepatocellular carcinoma subtypes. The distribution of the major features and categories of LI-RADS is not different among the HCC histological subtypes. MTM-HCC was associated with TIV, ≥1 LR-M feature, infiltrative appearance, necrosis or severe ischaemia, and larger size. Steatohepatitis-related HCC was associated with fat in mass on CT and on MRI.
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Key Words
- ALT, alanine transaminase
- APHE, arterial phase hyperenhancement
- AST, aspartate aminotransferase
- CT, computed tomography
- Computed tomography
- HBP, hepatobiliary phase
- HCC, hepatocellular carcinoma
- Hepatocellular carcinoma
- Histopathological subtypes
- LI-RADS
- LI-RADS, Liver Imaging Reporting and Data System
- MRI, magnetic resonance imaging
- MTM-HCC, macrotrabecular-massive hepatocellular carcinoma
- Magnetic resonance imaging
- NOS-HCC, not otherwise specified hepatocellular carcinoma
- OS, overall survival
- RFS, recurrence-free survival
- SH-HCC, steatohepatitic hepatocellular carcinoma
- TIV, tumour-in-vein
- US, ultrasound
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Affiliation(s)
- Roberto Cannella
- Department of Radiology, Hôpital Beaujon, Clichy, France.,Section of Radiology-BiND, University Hospital 'Paolo Giaccone', Palermo, Italy.,Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, Clichy, France.,Université de Paris, INSERM U1149 'centre de recherche sur l'inflammation', CRI, Paris, France
| | | | - Loïc Trapani
- Department of Pathology, Hôpital Beaujon, Clichy, France
| | | | - Christian Hobeika
- Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - Francois Cauchy
- Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | | | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, Clichy, France.,Université de Paris, INSERM U1149 'centre de recherche sur l'inflammation', CRI, Paris, France
| | - Riccardo Sartoris
- Department of Radiology, Hôpital Beaujon, Clichy, France.,Université de Paris, INSERM U1149 'centre de recherche sur l'inflammation', CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, Clichy, France.,Université de Paris, INSERM U1149 'centre de recherche sur l'inflammation', CRI, Paris, France
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12
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Brustia R, Laurent A, Goumard C, Langella S, Cherqui D, Kawai T, Soubrane O, Cauchy F, Farges O, Menahem B, Hobeika C, Rhaiem R, Sommacale D, Okumura S, Hofmeyr S, Ferrero A, Pruvot FR, Regimbeau JM, Fuks D, Vibert E, Scatton O. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching. Surgery 2021; 171:1290-1302. [PMID: 34535270 DOI: 10.1016/j.surg.2021.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient. The primary aim of this study was to compare overall survival for a large series of patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach. Secondary objectives were to compare disease-free survival, predictors of death, and recurrence. METHODS Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma from 2000 to 2018 from 3 large international databases were analyzed retrospectively. Each patient in the laparoscopic resection group (case) was matched with 1 open resection control (1:1 ratio), through a propensity score calculated on clinically relevant preoperative covariates. Overall and disease-free survival were compared between the matched groups. Predictors of mortality and recurrence were analyzed with Cox regression, and the Textbook Outcomes were described. RESULTS During the study period, 855 patients met the inclusion criteria (open liver resection = 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients each were analyzed after propensity score matching, with no significant difference regarding pre- and postoperative variables. Overall survival at 1, 3, and 5 years was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and 49% in the open liver resection group (P = .0043). Adjusted Cox regression revealed severe postoperative complications (hazard ratio: 10.5, 95% confidence interval [1.01-109] P = .049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23-154] P = .033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence interval [4.04-91.4] P < .001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence interval [1.15-14.4] P = .030) as predictors of recurrence. CONCLUSION The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data.
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Affiliation(s)
- Raffaele Brustia
- Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France. https://twitter.com/raffaele.brustia
| | - Alexis Laurent
- Univ Paris Est Creteil, Faculté de Santé, Créteil, France and Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Claire Goumard
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | - Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano, Torino, Italy
| | - Daniel Cherqui
- Centre Hepato-Biliaire, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Takayuki Kawai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Olivier Soubrane
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Francois Cauchy
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Olivier Farges
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, France
| | - Christian Hobeika
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | - Rami Rhaiem
- Department of Hepatobiliary, Pancreatic, and Digestive Surgery, Robert Debré University Hospital, Reims, France University Reims Champagne-Ardenne, France
| | - Daniele Sommacale
- Univ Paris Est Creteil, Faculté de Santé, Créteil, France and Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Shinya Okumura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Stefan Hofmeyr
- Division of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Ospedale Mauriziano, Torino, Italy
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, Univ Lille, CHRU Lille, Lille, France
| | - Jean-Marc Regimbeau
- SSPC (Simplification of Surgical Patients Care), Clinical Research Unit, University of Picardie Jules Verne, Amiens, France and Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - David Fuks
- Department of Digestive, Oncologic, and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Eric Vibert
- Centre Hepato-Biliaire, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Olivier Scatton
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France.
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Hobeika C, Cauchy F, Fuks D, Barbier L, Fabre JM, Boleslawski E, Regimbeau JM, Farges O, Pruvot FR, Pessaux P, Salamé E, Soubrane O, Vibert E, Scatton O. Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis. Br J Surg 2021; 108:419-426. [PMID: 33793726 DOI: 10.1093/bjs/znaa110] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/28/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). METHODS Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching. RESULTS In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012). CONCLUSION The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France.,Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
| | - F Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - D Fuks
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Université Paris V, Paris, France
| | - L Barbier
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - J M Fabre
- Department of Digestive, Hepatopancreatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - E Boleslawski
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - J M Regimbeau
- Department of Digestive Surgery, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - O Farges
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - F R Pruvot
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - P Pessaux
- Department of Digestive Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - E Salamé
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - O Soubrane
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - E Vibert
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Assistance Publique-Hopitaux de Paris and Université Paris XI, Paris, France
| | - O Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
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Hobeika C, Cauchy F. Reply: Commentary on 'laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis'. Br J Surg 2021; 108:e309. [PMID: 34270694 DOI: 10.1093/bjs/znab172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/11/2021] [Indexed: 11/13/2022]
Affiliation(s)
- C Hobeika
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
| | - F Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris and Université de Paris, France
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15
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Hobeika C, Cauchy F. Reply: Can laparoscopic approach improve quality of care of patients with resectable intrahepatic cholangiocarcinoma? (Comment on 'laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis'). Br J Surg 2021; 108:e311. [PMID: 34000027 DOI: 10.1093/bjs/znab174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/14/2022]
Affiliation(s)
- C Hobeika
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
| | - F Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris and Université de Paris, France
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16
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Voron T, Moszkowicz D, Hobeika C, Collard M, Bruzzi M, Beghdadi N, Catry J, Duchalais E, Manceau G, Lakkis Z, Allard MA, Cauchy F, Maggiori L. Re: Moszkowicz D, et al. "Operating room hygiene: Clinical practice recommendations SFCD-ACHBT". J Visc Surg 2021; 158:285-286. [PMID: 33583727 DOI: 10.1016/j.jviscsurg.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- T Voron
- Department of General and Digestive Surgery, Saint Antoine Hospital, Assistance Publique des Hôpitaux de Paris (APHP), University of Paris 6, France
| | - D Moszkowicz
- General and digestive surgery department, Louis Mourier Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris, France
| | - C Hobeika
- Service de chirurgie digestive, hépato-bilio-pancréatique et transplantation, Pitié-Salpétrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris 6, France
| | - M Collard
- Department of digestive, hepato-bilio-pancreatic and transplantation surgery, Beaujon Hospital, Paris, Assistance Publique Hôpitaux de Paris, (APHP), University of Paris, France
| | - M Bruzzi
- Department of digestive surgery, Européen Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris, France
| | - N Beghdadi
- Hepatobiliary Center, Paul Brousse Hospital, Assistance Publique des Hôpitaux de Paris (APHP), University of Paris 11, France
| | - J Catry
- Department of General, Digestive and Endocrine Surgery, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris (APHP), University of Paris, France
| | - E Duchalais
- Department of Digestive and Endocrine Surgery, CHU Nantes, University of Nantes, France
| | - G Manceau
- Service de chirurgie digestive, hépato-bilio-pancréatique et transplantation, Pitié-Salpétrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris 6, France
| | - Z Lakkis
- Department of Visceral, Digestive and Cancer Surgery, CHRU Besançon, University of Franche-Comté, France
| | - M-A Allard
- Department of digestive surgery, Européen Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris, France
| | - F Cauchy
- Department of digestive, hepato-bilio-pancreatic and transplantation surgery, Beaujon Hospital, Paris, Assistance Publique Hôpitaux de Paris, (APHP), University of Paris, France
| | - L Maggiori
- Department of General, Digestive and Endocrine Surgery, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris (APHP), University of Paris, France.
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17
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Amaddeo G, Brustia R, Allaire M, Lequoy M, Hollande C, Regnault H, Blaise L, Ganne-Carrié N, Séror O, Larrey E, Lim C, Scatton O, El Mouhadi S, Ozenne V, Paye F, Balladur P, Dohan A, Massault PP, Pol S, Dioguardi Burgio M, Vilgrain V, Sepulveda A, Cauchy F, Luciani A, Sommacale D, Leroy V, Roudot-Thoraval F, Bouattour M, Nault JC. Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area. JHEP Rep 2021; 3:100199. [PMID: 33163949 PMCID: PMC7604130 DOI: 10.1016/j.jhepr.2020.100199] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/29/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Patients affected by hepatocellular carcinoma (HCC) represent a vulnerable population during the COVID-19 pandemic and may suffer from altered allocation of healthcare resources. The aim of this study was to determine the impact of the COVID-19 pandemic on the management of patients with HCC within 6 referral centres in the metropolitan area of Paris, France. METHODS We performed a multicentre, retrospective, cross-sectional study on the management of patients with HCC during the first 6 weeks of the COVID-19 pandemic (exposed group), compared with the same period in 2019 (unexposed group). We included all patients discussed in multidisciplinary tumour board (MTB) meetings and/or patients undergoing a radiological or surgical programmed procedure during the study period, with curative or palliative intent. Endpoints were the number of patients with a modification in the treatment strategy, or a delay in decision-to-treat. RESULTS After screening, n = 670 patients were included (n = 293 exposed to COVID, n = 377 unexposed to COVID). Fewer patients with HCC presented to the MTB in 2020 (p = 0.034) and fewer had a first diagnosis of HCC (n = 104 exposed to COVID, n = 143 unexposed to COVID, p = 0.083). Treatment strategy was modified in 13.1% of patients, with no differences between the 2 periods. Nevertheless, 21.5% vs. 9.5% of patients experienced a treatment delay longer than 1 month in 2020 compared with 2019 (p <0.001). In 2020, 7.1% (21/293) of patients had a diagnosis of an active COVID-19 infection: 11 (52.4%) patients were hospitalised and 4 (19.1%) patients died. CONCLUSIONS In a metropolitan area highly impacted by the COVID-19 pandemic, we observed fewer patients with HCC, and similar rates of treatment modification, but with a significantly longer treatment delay in 2020 vs. 2019. LAY SUMMARY During the coronavirus disease 2019 (COVID-19) pandemic era, fewer patients with hepatocellular carcinoma (HCC) presented to the multidisciplinary tumour board, especially with a first diagnosis of HCC. Patients with HCC had a treatment delay that was longer in the COVID-19 period than in 2019.
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Key Words
- 2019-nCoV
- BCLC, Barcelona Clinic Liver Cancer
- COVID-19
- Cirrhosis
- EASL, European Association for the Study of Liver
- HCC, hepatocellular carcinoma
- Hepatocellular carcinoma
- ICU, intensive care unit
- IQR, inter-quartile range
- IR, interventional radiology
- ITT, intention to treat
- LR, liver resection
- LT, liver transplantation
- MELD, model for end-stage liver disease
- MTB, multidisciplinary tumour board
- Management
- NASH, non-alcoholic steatohepatitis
- OR, odds ratio
- SIRT, selective internal radiation therapy
- TACE, transarterial chemoembolisation
- aOR, adjusted OR
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Affiliation(s)
- Giuliana Amaddeo
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Raffaele Brustia
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Manon Allaire
- Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Marie Lequoy
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
| | | | - Hélène Regnault
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Lorraine Blaise
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Nathalie Ganne-Carrié
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Olivier Séror
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
| | - Edouard Larrey
- Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Chetana Lim
- Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Olivier Scatton
- Sorbonne Université, Paris, France
- Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Sanaa El Mouhadi
- Department of Radiology, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Violaine Ozenne
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
| | - François Paye
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Pierre Balladur
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Anthony Dohan
- Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | | | - Stanislas Pol
- Department of Hepatology, AP-HP, Hôpital Cochin, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
| | - Ailton Sepulveda
- Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Francois Cauchy
- Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Alain Luciani
- Paris Est Créteil University, UPEC, Créteil, France
- Department of Radiology, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Daniele Sommacale
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Vincent Leroy
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | | | - Mohamed Bouattour
- Département d'Oncologie Digestive, AP-HP, Hôpital Beaujon, Clichy, France
| | - Jean-Charles Nault
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Paris Liver Cancer Group‡
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Paris, France
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
- Department of Hepatology, AP-HP, Hôpital Cochin, Paris, France
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
- Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Department of Radiology, AP-HP, Hôpital Saint Antoine, Paris, France
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
- Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
- Department of Digestive Surgery, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
- Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- Department of Radiology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Département d'Oncologie Digestive, AP-HP, Hôpital Beaujon, Clichy, France
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Hobeika C, Cauchy F, Weiss E, Chopinet S, Sepulveda A, Dondero F, Khoy-Ear L, Grigoresco B, Dokmak S, Durand F, Le Roy B, Paugam-Burtz C, Soubrane O. Practical model to identify liver transplant recipients at low risk of postoperative haemorrhage, bile leakage and ascites. BJS Open 2021; 5:6073666. [PMID: 33609380 PMCID: PMC7893463 DOI: 10.1093/bjsopen/zraa031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background This study aimed to identify a subgroup of recipients at low risk of haemorrhage, bile leakage and ascites following liver transplantation (LT). Methods Factors associated with significant postoperative ascites (more than 10 ml/kg on postoperative day 5), bile leakage and haemorrhage after LT were identified using three separate multivariable analyses in patients who had LT in 2010–2019. A model predicting the absence of all three outcomes was created and validated internally using bootstrap procedure. Results Overall, 944 recipients underwent LT. Rates of ascites, bile leakage and haemorrhage were 34.9, 7.7 and 6.0 per cent respectively. The 90-day mortality rate was 7.0 per cent. Partial liver graft (relative risk (RR) 1.31; P = 0.021), intraoperative ascites (more than 10 ml/kg suctioned after laparotomy) (RR 2.05; P = 0.001), malnutrition (RR 1.27; P = 0.006), portal vein thrombosis (RR 1.56; P = 0.024) and intraoperative blood loss greater than 1000 ml (RR 1.39; P = 0.003) were independently associated with postoperative ascites and/or bile leak and/or haemorrhage, and were introduced in the model. The model was well calibrated and predicted the absence of all three outcomes with an area under the curve of 0.76 (P = 0.001). Of the 944 patients, 218 (23.1 per cent) fulfilled the five criteria of the model, and 9.6 per cent experienced postoperative ascites (RR 0.22; P = 0.001), 1.8 per cent haemorrhage (RR 0.21; P = 0.033), 4.1 per cent bile leak (RR 0.54; P = 0.048), 40.4 per cent severe complications (RR 0.70; P = 0.001) and 1.4 per cent 90-day mortality (RR 0.13; P = 0.004). Conclusion A practical model has been provided to identify patients at low risk of ascites, bile leakage and haemorrhage after LT; these patients could potentially qualify for inclusion in non-abdominal drainage protocols.
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Affiliation(s)
- C Hobeika
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Cauchy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - E Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - S Chopinet
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - A Sepulveda
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Dondero
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - L Khoy-Ear
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - B Grigoresco
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - S Dokmak
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Durand
- Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - B Le Roy
- Department of Digestive and Oncological Surgery, Centre Hospitalier Universitaire Nord Saint-Etienne, Saint-Priest en Jarez, France
| | - C Paugam-Burtz
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - O Soubrane
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
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19
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D'Souza MA, Valdimarsson VT, Campagnaro T, Cauchy F, Chatzizacharias NA, D'Hondt M, Dasari B, Ferrero A, Franken LC, Fusai G, Guglielmi A, Hagendoorn J, Hidalgo Salinas C, Hoogwater FJH, Jorba R, Karanjia N, Knoefel WT, Kron P, Lahiri R, Langella S, Le Roy B, Lehwald-Tywuschik N, Lesurtel M, Li J, Lodge JPA, Martinou E, Molenaar IQ, Nikov A, Poves I, Rassam F, Russolillo N, Soubrane O, Stättner S, van Dam RM, van Gulik TM, Serrablo A, Gallagher TM, Sturesson C. Hepatopancreatoduodenectomy -a controversial treatment for bile duct and gallbladder cancer from a European perspective. HPB (Oxford) 2020; 22:1339-1348. [PMID: 31899044 DOI: 10.1016/j.hpb.2019.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/22/2019] [Accepted: 12/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain oncological benefit in terms of survival. Few reports on HPD from Western centers exist. The purpose of this study was to evaluate safety and efficacy for HPD in European centers. METHOD Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients operated with HPD for bile duct or gallbladder cancer between January 2003 and January 2018. The patient and tumor characteristics, perioperative and survival outcomes were analyzed. RESULTS In total, 66 patients from 19 European centers were included in the analysis. 90-day mortality rate was 17% and 13% for bile duct and gallbladder cancer respectively. All factors predictive of perioperative mortality were patient and disease-specific. The three-year overall survival excluding 90-day mortality was 80% for bile duct and 30% for gallbladder cancer (P = 0.013). In multivariable analysis R0-resection had a significant impact on overall survival. CONCLUSION HPD, although being associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with bile duct cancer and gallbladder cancer. To achieve negative resection margins is paramount for an improved survival outcome.
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Affiliation(s)
- Melroy A D'Souza
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Valentinus T Valdimarsson
- Department of Clinical Sciences Lund, Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Tommaso Campagnaro
- Department of Surgery, General and Hepatobiliary Surgery Unit, Verona University Hospital, Verona, Italy
| | - Francois Cauchy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Nikolaos A Chatzizacharias
- Department of Hepatobiliary and Pancreatic Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Kortrijk, Belgium
| | - Bobby Dasari
- Department of Hepatobiliary and Pancreatic Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Alessandro Ferrero
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Lotte C Franken
- Department of Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - Giuseppe Fusai
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London, United Kingdom
| | - Alfredo Guglielmi
- Department of Surgery, General and Hepatobiliary Surgery Unit, Verona University Hospital, Verona, Italy
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Camila Hidalgo Salinas
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London, United Kingdom
| | - Frederik J H Hoogwater
- Department of Surgery, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rosa Jorba
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Nariman Karanjia
- Surrey and Sussex Regional HPB Unit, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Wolfram T Knoefel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - Philipp Kron
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rajiv Lahiri
- Surrey and Sussex Regional HPB Unit, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Serena Langella
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Bertrand Le Roy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Nadja Lehwald-Tywuschik
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - Mickael Lesurtel
- Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, University of Lyon, Lyon, France
| | - Jun Li
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Peter A Lodge
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Erini Martinou
- Surrey and Sussex Regional HPB Unit, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Izaak Q Molenaar
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Andrej Nikov
- Department of Surgery, 2 Faculty of Medicine, Charles University and Central Military Hospital, Prague, 16002, Czech Republic
| | - Ignasi Poves
- Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Fadi Rassam
- Department of Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - Nadia Russolillo
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Stefan Stättner
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronald M van Dam
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - Alejandro Serrablo
- Hepatobiliopancreatic Surgery Unit, General and Digestive Surgery Service, Hospital Miguel Servet, Zaragoza, Spain
| | - Tom M Gallagher
- Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park, Dublin, Ireland
| | - Christian Sturesson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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Hobeika C, Cauchy F, Sartoris R, Beaufrère A, Yoh T, Vilgrain V, Rautou PE, Paradis V, Bouattour M, Ronot M, Soubrane O. Relevance of liver surface nodularity for preoperative risk assessment in patients with resectable hepatocellular carcinoma. Br J Surg 2020; 107:878-888. [PMID: 32118298 DOI: 10.1002/bjs.11511] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/08/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Quantification of liver surface nodularity (LSN) on routine preoperative CT images allows detection of cirrhosis and clinically significant portal hypertension. This study aimed to assess the relevance of LSN in preoperative assessment of operative risks for patients with resectable hepatocellular carcinoma (HCC). METHODS All patients undergoing hepatectomy for HCC between 2012 and 2017 were analysed retrospectively. LSN was assessed at the liver-fat interface on the left liver lobe on preoperative CT images. The feasibility of LSN quantification was assessed. The association between LSN and outcomes (severe complications and posthepatectomy liver failure (PHLF)) was evaluated by multivariable analysis and after propensity score matching. RESULTS Among 210 patients, LSN measurement was successful in 187 (89·0 per cent). Among these, the median LSN score was 2·42 (i.q.r. 2·21-2·66) and 52·9 per cent had severe fibrosis, including 33·7 per cent with cirrhosis. LSN score increased with hepatic venous pressure gradient (P = 0·048), severity of steatosis (P = 0·011) and fibrosis grade (P = 0·001). LSN score was independently associated with severe complications (odds ratio (OR) 5·25; P = 0·006) and PHLF (OR 6·78; P = 0·003). After matching with respect to model for end-stage liver disease, aspartate aminotransferase-to-platelet ratio index and fibrosis-4 score, patients with a LSN score of 2·63 or higher retained an increased risk of PHLF (OR 5·81; P = 0·018). In the subgroup of patients without severe fibrosis, LSN was accurate in predicting severe complications (P = 0·005). Patients with (P = 0·039) or without (P = 0·018) severe fibrosis with increased LSN score had a higher comprehensive complication index score. Among patients with cirrhosis who had clinically significant portal hypertension, a LSN value below 2·63 ruled out the risk of PHLF. CONCLUSION LSN measurement represents a practical tool that may allow improvement in the preoperative evaluation and management of patients with HCC.
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Affiliation(s)
- C Hobeika
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Cauchy
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - R Sartoris
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - A Beaufrère
- Department of Pathology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - T Yoh
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - V Vilgrain
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - P E Rautou
- Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - V Paradis
- Department of Pathology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - M Bouattour
- Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - M Ronot
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - O Soubrane
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
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21
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Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, Patrice D. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg 2020; 107:268-277. [PMID: 31916594 DOI: 10.1002/bjs.11406] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - F Cauchy
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - C Goumard
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - O Soubrane
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - E Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France
| | - D Cherqui
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - E Vibert
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - O Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | | | - T Nomi
- Nara Medical University, Nara, Japan
| | - N Oudafal
- Institut Mutualiste Montsouris, Paris, France
| | - T Kawai
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Komatsu
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Okumura
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - A Laurent
- Hôpital Henri Mondor, APHP, Creteil, France
| | - P Bucur
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - L Barbier
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - B Trechot
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - J Nunèz
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M Tedeschi
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M-A Allard
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - N Golse
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - O Ciacio
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - G Pittau
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - C Laurent
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - L Chiche
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - P Leourier
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Rebibo
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - J-M Regimbeau
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Ferre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F R Souche
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J Chauvat
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J-M Fabre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F Jehaes
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Lesurtel
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Ducerf
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-Y Mabrut
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - T Hor
- St Antoine Hospital, APHP, Paris, France
| | - F Paye
- St Antoine Hospital, APHP, Paris, France
| | - P Balladur
- St Antoine Hospital, APHP, Paris, France
| | - B Suc
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - F Muscari
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - G Millet
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - M El Amrani
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - C Ratajczak
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - K Lecolle
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - E Boleslawski
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - S Truant
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - F-R Pruvot
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - A-R Kianmanesh
- Robert Debré Hospital, Hospital University Centre of Reims, Reims, France
| | - T Codjia
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - L Schwarz
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - E Girard
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - J Abba
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - C Letoublon
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - M Chirica
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | | | | | - Z Cherkaoui
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - X Unterteiner
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - R Memeo
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - P Pessaux
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - E Buc
- Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Lermite
- Hospital University Centre of Angers, Angers, France
| | - J Barbieux
- Hospital University Centre of Angers, Angers, France
| | - M Bougard
- Hospital University Centre of Angers, Angers, France
| | - U Marchese
- Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Institut Paoli-Calmettes, Marseille, France
| | - O Turini
- Institut Paoli-Calmettes, Marseille, France
| | - A Thobie
- Hospital University Centre of Caen Normandie, Caen, France
| | - B Menahem
- Hospital University Centre of Caen Normandie, Caen, France
| | - A Mulliri
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Lubrano
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Zemour
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - H Fagot
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - G Passot
- Hospital University Centre of Lyon Sud, Lyon, France
| | - E Gregoire
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - J Hardwigsen
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - Y-P le Treut
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - D Patrice
- Louis Pasteur Hospital, Colmar, France
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Abstract
In Europe, the prevalence of metabolic syndrome (MS) has reached the endemic rate of 25%. Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of MS. Its definition is histological, bringing together the different lesions associated with hepatic steatosis (fat deposits on more than 5% of hepatocytes) without alcohol consumption and following exclusion of other causes. MS and NAFLD are implicated in the carcinogenesis of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). At present, HCC and ICC involving MS represent 15-20% and 20-30% respectively of indications for hepatic resection in HCC and ICC. Moreover, in the industrialized nations NAFLD is tending to become the most frequent indication for liver transplantation. MS patients combine the operative risk associated with their general condition and comorbidities and the risk associated with the presence and/or severity of NAFLD. Following hepatic resection in cases of HCC and ICC complicating MS, the morbidity rate ranges from 20 to 30%, and due to cardiovascular and infectious complications, post-transplantation mortality is heightened. The operative risk incurred by MS patients necessitates appropriate management including: (i) precise characterization of the subjacent liver; (ii) an accurately targeted approach privileging detection and optimization of treatment taking into account the relevant cardiovascular risk factors; (iii) a surgical strategy adapted to the histology of the underlying liver, with optimization of the volume of the remaining (postoperative) liver.
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Affiliation(s)
- C Hobeika
- Service de chirurgie hépato-bilio-pancréatique et transplantation hépatique, Hôpital Beaujon, AP-HP et Université de Paris, 100, boulevard du Général Leclerc, 92110, Clichy, France
| | - M Ronot
- Service de radiologie, Hôpital Beaujon, AP-HP et Université de Paris, 100, boulevard du Général Leclerc, 92110, Clichy, France
| | - A Beaufrere
- Service d'anatomo-pathologie, Hôpital Beaujon, AP-HP et Université de Paris, 100, boulevard du Général Leclerc, 92110, Clichy, France
| | - V Paradis
- Service d'anatomo-pathologie, Hôpital Beaujon, AP-HP et Université de Paris, 100, boulevard du Général Leclerc, 92110, Clichy, France
| | - O Soubrane
- Service de chirurgie hépato-bilio-pancréatique et transplantation hépatique, Hôpital Beaujon, AP-HP et Université de Paris, 100, boulevard du Général Leclerc, 92110, Clichy, France
| | - F Cauchy
- Service de chirurgie hépato-bilio-pancréatique et transplantation hépatique, Hôpital Beaujon, AP-HP et Université de Paris, 100, boulevard du Général Leclerc, 92110, Clichy, France.
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23
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Moszkowicz D, Hobeika C, Collard M, Bruzzi M, Beghdadi N, Catry J, Duchalais E, Manceau G, Voron T, Lakkis Z, Allard MA, Cauchy F, Maggiori L. Operating room hygiene: Clinical practice recommendations. J Visc Surg 2019; 156:413-422. [DOI: 10.1016/j.jviscsurg.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Asymptomatic right diaphragmatic rupture with liver and gallbladder herniation and secondary Budd-Chiari syndrome is a rare complication of abdominal trauma. In this setting, the management of gallbladder stones remains poorly described and may require a thoracic approach.
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Affiliation(s)
- M Paci
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, Université Paris VII Diderot, Assistance Publique-Hôpitaux de Paris, 100, boulevard du Général Leclerc, 92110 Clichy, Paris, France; Department of General Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - F Cauchy
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, Université Paris VII Diderot, Assistance Publique-Hôpitaux de Paris, 100, boulevard du Général Leclerc, 92110 Clichy, Paris, France.
| | - O Farges
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, Université Paris VII Diderot, Assistance Publique-Hôpitaux de Paris, 100, boulevard du Général Leclerc, 92110 Clichy, Paris, France
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Barbier L, Calmels M, Lagadec M, Gauss T, Abback PS, Cauchy F, Ronot M, Soubrane O, Paugam-Burtz C. Can we refine the management of blunt liver trauma? J Visc Surg 2018; 156:23-29. [PMID: 29622405 DOI: 10.1016/j.jviscsurg.2018.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM To describe the management of blunt liver injury and to study the potential relation between delayed complications, type of trauma mechanisms and liver lesions. PATIENTS AND METHODS This is a retrospective single center study including 116 consecutive patients admitted with blunt liver injury between 2007 and 2015. RESULTS Initial CT-scan identified an active bleeding in 33 (28%) patients. AAST (American Association for the Surgery of Trauma) grade was 1 to 3 in 82 (71%) patients and equal to 5 in 15 (13%) patients. Eighty (69%) patients had NOM, with a success rate of 96%. Other abdominal organ lesions were associated to invasive initial management. A follow-up CT-scan was useful to detect hepatic and extra-hepatic complications (46 complications in 80 patients), even without clinical or biological abnormalities. Subsequent hepatic complications such as bleeding, pseudo aneurysms, biloma and biliary peritonitis developed in 15 patients and were associated with the severity of blunt liver injury according to AAST classification (3.7±1.0 vs. 3.0±1.1, P=0.010). Total biliary complications occurred in 13 patients and were significantly more frequently observed in patients with injury of central segments 1, 4 and 9 (69% vs. 36%, P=0.033). CONCLUSIONS Non-operative management is possible in most blunt liver injury with a success rate of 96%. A systematic CT-scan should be advocated during follow-up, especially when AAST grade is equal or superior to 3. Biliary complications should be suspected when lesions involve segments 1, 4 and 9.
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Affiliation(s)
- L Barbier
- HPB Surgery, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France; Department of Digestive Surgery, hôpital Trousseau, université Rabelais, Tours, FHU SUPORT, France.
| | - M Calmels
- HPB Surgery, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France
| | - M Lagadec
- Radiology, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France
| | - T Gauss
- Department of Anesthesiology and Critical Care, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France
| | - P-S Abback
- Department of Anesthesiology and Critical Care, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France
| | - F Cauchy
- HPB Surgery, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France
| | - M Ronot
- Radiology, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France
| | - O Soubrane
- HPB Surgery, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France
| | - C Paugam-Burtz
- Department of Anesthesiology and Critical Care, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France
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Cesaretti M, Poté N, Cauchy F, Dondero F, Dokmak S, Sepulveda A, Schneck AS, Francoz C, Durand F, Paradis V, Soubrane O. Noninvasive assessment of liver steatosis in deceased donors: A pilot study. Liver Transpl 2018; 24:551-556. [PMID: 29272077 DOI: 10.1002/lt.25002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/01/2017] [Accepted: 12/16/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Manuela Cesaretti
- Departments of HPB Surgery and Liver Transplantation, Beaujon Hospital, AP-HPUniversité Paris VII Paris-Diderot, INSERM U1149, Clichy, France.,Istituto Italiano di Tecnologia, Genova, Italy
| | - Nicolas Poté
- Department of Pathology, DHU UNITY, Beaujon Hospital, AP-HPUniversité Paris VII Paris-Diderot, INSERM U1149, Clichy, France
| | - Francois Cauchy
- Departments of HPB Surgery and Liver Transplantation, Beaujon Hospital, AP-HPUniversité Paris VII Paris-Diderot, INSERM U1149, Clichy, France
| | - Federica Dondero
- Departments of HPB Surgery and Liver Transplantation, Beaujon Hospital, AP-HPUniversité Paris VII Paris-Diderot, INSERM U1149, Clichy, France
| | - Safi Dokmak
- Departments of HPB Surgery and Liver Transplantation, Beaujon Hospital, AP-HPUniversité Paris VII Paris-Diderot, INSERM U1149, Clichy, France
| | - Ailton Sepulveda
- Departments of HPB Surgery and Liver Transplantation, Beaujon Hospital, AP-HPUniversité Paris VII Paris-Diderot, INSERM U1149, Clichy, France
| | - Anne Sophie Schneck
- Departments of HPB Surgery and Liver Transplantation, Beaujon Hospital, AP-HPUniversité Paris VII Paris-Diderot, INSERM U1149, Clichy, France
| | - Claire Francoz
- Department of Hepatology and Liver Intensive Care Beaujon Hospital AP-HP, Université Paris VII Paris-Diderot INSERM U1149, Clichy, France
| | - Francois Durand
- Department of Hepatology and Liver Intensive Care Beaujon Hospital AP-HP, Université Paris VII Paris-Diderot INSERM U1149, Clichy, France
| | - Valerie Paradis
- Department of Pathology, DHU UNITY, Beaujon Hospital, AP-HPUniversité Paris VII Paris-Diderot, INSERM U1149, Clichy, France
| | - Olivier Soubrane
- Departments of HPB Surgery and Liver Transplantation, Beaujon Hospital, AP-HPUniversité Paris VII Paris-Diderot, INSERM U1149, Clichy, France
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Rouet J, Bwelle G, Cauchy F, Masso-Misse P, Gaujoux S, Dousset B. Polyester mosquito net mesh for inguinal hernia repair: A feasible option in resource limited settings in Cameroon? J Visc Surg 2018; 155:111-116. [DOI: 10.1016/j.jviscsurg.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leporq B, Lambert SA, Ronot M, Boucenna I, Colinart P, Cauchy F, Vilgrain V, Paradis V, Van Beers BE. Hepatic fat fraction and visceral adipose tissue fatty acid composition in mice: Quantification with 7.0T MRI. Magn Reson Med 2015; 76:510-8. [PMID: 26527483 DOI: 10.1002/mrm.25895] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 07/23/2015] [Accepted: 07/25/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE To develop an MRI method for quantifying hepatic fat content and visceral adipose tissue fatty acid composition in mice on a 7.0T preclinical system. METHODS MR acquisitions were performed with a multiple echo spoiled gradient echo with bipolar readout gradients. After phase correction, the number of double bounds (ndb) and the number of methylene interrupted double bounds (nmidb) were quantified with a model including eight fat components, and parametric maps of saturated, monounsaturated, and polyunsaturated fatty acids were derived. The model included a complex error map to correct for the phase errors and the amplitude modulation caused by the bipolar acquisition. Validations were performed in fat-water emulsions and vegetable oils. In vivo, the feasibility was evaluated in mice receiving a high-fat diet containing primarily saturated fatty acids and a low-fat diet containing primarily unsaturated fatty acids. RESULTS Linear regressions showed strong agreements between ndb and nmidb quantified with MRI and the theoretical values calculated using oil compositions, as well as between the proton density and the fat fractions in the emulsions. At MRI, the mouse liver fat fraction was smaller in mice fed the low-fat diet compared with mice fed the high-fat diet. In visceral adipose tissue, saturated fatty acids were significantly higher, whereas monounsaturated and polyunsaturated fatty acids were significantly lower in mice fed the low-fat diet compared with mice fed the high-fat diet. CONCLUSION It is feasible to simultaneously quantify hepatic fat content and visceral adipose tissue fatty acid composition with 7.0T MRI in mice. Magn Reson Med 76:510-518, 2016. © 2015 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Affiliation(s)
- Benjamin Leporq
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR1149 INSERM-University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Simon A Lambert
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR1149 INSERM-University Paris Diderot, Sorbonne Paris Cité, Paris, France.,BHF Centre of Excellence, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Maxime Ronot
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR1149 INSERM-University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Radiology, Beaujon University Hospital Paris Nord, Clichy, France
| | - Imane Boucenna
- Matière et Systèmes Complexes, UMR 7057 CNRS-University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Pierre Colinart
- Matière et Systèmes Complexes, UMR 7057 CNRS-University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Francois Cauchy
- Department of HPB and liver transplantation, Beaujon University Hospital Paris Nord, Clichy, France
| | - Valerie Vilgrain
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR1149 INSERM-University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Radiology, Beaujon University Hospital Paris Nord, Clichy, France
| | - Valerie Paradis
- Department of Pathology, Beaujon University Hospital Paris Nord, Clichy, France
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR1149 INSERM-University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Radiology, Beaujon University Hospital Paris Nord, Clichy, France
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Scatton O, Goumard C, Cauchy F, Fartoux L, Perdigao F, Conti F, Calmus Y, Boelle PY, Belghiti J, Rosmorduc O, Soubrane O. Early and resectable HCC: Definition and validation of a subgroup of patients who could avoid liver transplantation. J Surg Oncol 2015; 111:1007-15. [PMID: 25918872 DOI: 10.1002/jso.23916] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/16/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Liver transplantation (LT) remains the best curative option for early hepatocellular carcinoma (HCC) but is limited by the ongoing graft shortage. The present study aimed at defining the population in which primary liver resection (LR) could represent the best alternative to LT. METHODS An exploration set of 357 HCC patients (LR n = 221 and LT n = 136) operated between 2000-2012 was used in order to identify factors associated with survival following LR and define a good prognosis (GP) group for which LR may challenge the results of upfront LT. These factors were validated in an external validation set of 565 HCC patients operated at another center (LR n = 287 LR and LT n = 278). RESULTS In the exploration set, factors associated with survival on multivariate analysis were a solitary lesion, a diameter <50 mm, a well-moderately differentiated lesion, the absence of microvascular invasion, and preoperative AST level <2N. Thirty-nine patients (18%) displayed all these criteria and constituted the GP patients. Overall survivals at 1, 3, and 5 years did not significantly differ between GP resected patients, and the in Milan transplanted patients (93, 80.4, and 80.4% vs. 86.9, 82, and 78.8%, P = 0.79). In the validation cohort, patients with GP factors of survival still displayed better overall survivals than those without (P = 0.036) but also displayed better survivals than in Milan HCC transplanted patients (P = 0.005). CONCLUSION In a group of early HCC patients gathering all factors of GP, primary LR achieves at least similar survival as upfront LT and should be the approach of choice.
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Affiliation(s)
- Olivier Scatton
- Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France. .,Université Pierre et Marie Curie, Paris 6.
| | - Claire Goumard
- Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France
| | - Francois Cauchy
- Department of Hepatobiliary surgery and Liver Transplantation, Hopital Beaujon, Assistance Publique Hopitaux de Paris, Paris, France
| | - Laetitia Fartoux
- Université Pierre et Marie Curie, Paris 6.,Department of Hepatology, Hopital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France
| | - Fabiano Perdigao
- Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France
| | - Filomena Conti
- Université Pierre et Marie Curie, Paris 6.,Department of Pathology, Hopital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France
| | - Yvon Calmus
- Université Pierre et Marie Curie, Paris 6.,Department of Pathology, Hopital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France
| | - Pierre Yves Boelle
- Department of Biostatistics, Hopital Saint Antoine, Assistance Publique Hopitaux de Paris, Paris, France
| | - Jacques Belghiti
- Department of Hepatobiliary surgery and Liver Transplantation, Hopital Beaujon, Assistance Publique Hopitaux de Paris, Paris, France
| | - Olivier Rosmorduc
- Université Pierre et Marie Curie, Paris 6.,Department of Hepatology, Hopital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France
| | - Olivier Soubrane
- Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.,Université Pierre et Marie Curie, Paris 6
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Cauchy F, Fuks D, Nomi T, Schwarz L, Barbier L, Dokmak S, Scatton O, Belghiti J, Soubrane O, Gayet B. Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg 2015; 102:785-95. [PMID: 25846843 DOI: 10.1002/bjs.9806] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/01/2015] [Accepted: 02/12/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although recent reports have suggested potential benefits of the laparoscopic approach in patients requiring major hepatectomy, it remains unclear whether conversion to open surgery could offset these advantages. This study aimed to determine the risk factors for and postoperative consequences of conversion in patients undergoing laparoscopic major hepatectomy (LMH). METHODS Data for all patients undergoing LMH between 2000 and 2013 at two tertiary referral centres were reviewed retrospectively. Risk factors for conversion were determined using multivariable analysis. After propensity score matching, the outcomes of patients who underwent conversion were compared with those of matched patients undergoing laparoscopic hepatectomy who did not have conversion, operated on at the same centres, and also with matched patients operated on at another tertiary centre during the same period by an open laparotomy approach. RESULTS Conversion was needed in 30 (13·5 per cent) of the 223 patients undergoing LMH. The most frequent reasons for conversion were bleeding and failure to progress, in 14 (47 per cent) and nine (30 per cent) patients respectively. On multivariable analysis, risk factors for conversion were patient age above 75 years (hazard ratio (HR) 7·72, 95 per cent c.i. 1·67 to 35·70; P = 0·009), diabetes (HR 4·51, 1·16 to 17·57; P = 0·030), body mass index (BMI) above 28 kg/m(2) (HR 6·41, 1·56 to 26·37; P = 0·010), tumour diameter greater than 10 cm (HR 8·91, 1·57 to 50·79; P = 0·014) and biliary reconstruction (HR 13·99, 1·82 to 238·13; P = 0·048). After propensity score matching, the complication rate in patients who had conversion was higher than in patients who did not (75 versus 47·3 per cent respectively; P = 0·038), but was not significantly different from the rate in patients treated by planned laparotomy (79 versus 67·9 per cent respectively; P = 0·438). CONCLUSION Conversion during LMH should be anticipated in patients with raised BMI, large lesions and biliary reconstruction. Conversion does not lead to increased morbidity compared with planned laparotomy.
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Affiliation(s)
- F Cauchy
- Department of Hepatobiliary and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of Hepatobiliary and Liver Transplantation, Hôpital Beaujon, Clichy, France
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Abstract
Hepatocellular adenoma (HCA) is a rare benign liver-cell neoplasm, occurring predominantly in young obese women using oral contraceptives. HCA is a heterogeneous disease, which includes four subtypes (including unclassified) associated with various risks of haemorrhagic complications and malignant transformation. Magnetic resonance imaging is the modality of choice for both diagnosis and subtype characterization of HCA whereas percutaneous biopsy has only limited impact on the therapeutic strategy. In men HCA should be always resected while in women surgery should only be considered for lesions ≥5 cm and after cessation of hormonal therapy. Women with single or multiple HCAs <5 cm may be followed with regular MRI imaging since the vast majority of HCA remains stable or decreases in size. Pregnancy should not be discouraged provided close sonographic surveillance is undertaken.
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Affiliation(s)
- Safi Dokmak
- Department of Hepatobiliary Surgery and Liver Transplantation Beaujon Hospital, AP-HP, University Paris-Diderot, Clichy, France
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Cauchy F, Benoist S, Gaujoux S, Régimbeau JM, Mariette C, Fuks D. What is the fate of the abstracts submitted at the French Congress of Digestive and Hepato-biliary Surgery? J Visc Surg 2014; 151:175-82. [PMID: 24861940 DOI: 10.1016/j.jviscsurg.2014.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
GOAL The aim of this study was to objectively analyze the characteristics of abstracts submitted to the annual joint congress of the SFCD (French Society of Digestive Surgery) and the ACBHT (Association of Hepato-biliary Surgery and Transplantation), in order to identify factors associated with acceptance for presentation at the Congress and of subsequent publication in a scientific journal. MATERIAL AND METHODS All abstracts submitted between 2005 and 2012 were retrospectively reviewed. Univariate and multivariate analysis were perfomed to determine the factors associated with acceptance for presentation at the Congress and/or for subsequent publication in the medical literature (based on PubMed). RESULTS The number of submissions increased from 128 in 2005 to 223 in 2012, i.e., an increase of 74.2%. Among the 1352 abstracts, 1106 (81.8%) were retrospective studies while only 15 (1.1%) were randomized controlled trials. The two principal themes were hepato-bilio-pancreatic surgery in 606 studies (44.8%) and colorectal surgery in 364 studies (26.9%). The overall rate of acceptance for the Congress was 49.9%, of which 21.0% were accepted for oral presentation. In multivariate analysis, the factors associated with acceptance for oral presentation were the geographic origin of the study (P<0.001), studies including >100 patients (P=0.01), and the prospective nature of the study (P=0.045). The rate of subsequent publication was 61.9% for studies accepted for oral presentation, 39.7% for studies accepted for poster presentation, and 25.9% for studies that were not accepted (P<0.001). In multivariate analysis, the factors associated with subsequent publication were geographic origin of the study (P=0.003), the experimental character of the study (P<0.001), and acceptance for presentation at the Congress (P<0.001). CONCLUSION Only half of the studies submitted for presentation at the annual Congress of the SFCD/ACBHT are accepted; this nevertheless constitutes a quality measure associated with nearly a 50% chance of subsequent publication in the medical literature.
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Affiliation(s)
- F Cauchy
- Service de chirurgie digestive, hôpital Bicêtre, 94275 Le Kremlin-Bicêtre, France
| | - S Benoist
- Service de chirurgie digestive, hôpital Bicêtre, 94275 Le Kremlin-Bicêtre, France
| | - S Gaujoux
- Service de chirurgie digestive, hôpital Cochin, 75014 Paris, France
| | - J-M Régimbeau
- Service de chirurgie digestive, hôpital Nord, 80054 Amiens cedex, France
| | - C Mariette
- Service de chirurgie digestive, hôpital Claude-Huriez, 59000 Lille, France
| | - D Fuks
- Département de pathologie digestive, institut mutualiste Montsouris, université Paris 5, 42, boulevard Jourdan, 75014 Paris, France.
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Cauchy F, Gaujoux S, Ronot M, Fuks D, Dokmak S, Sauvanet A, Belghiti J. Local Venous Thrombotic Risk of an Expanding Haemostatic Agent Used During Liver Resection. World J Surg 2014; 38:2363-9. [DOI: 10.1007/s00268-014-2552-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Cauchy F, Regimbeau JM, Fuks D, Balladur P, Tiret E, Paye F. Influence of bile duct obstruction on the results of Frey's procedure for chronic pancreatitis. Pancreatology 2013; 14:21-6. [PMID: 24555975 DOI: 10.1016/j.pan.2013.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 10/19/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the influence of a biliary obstruction (BO) requiring biliary bypass on both short and long-term outcomes of patients undergoing Frey's procedure for chronic pancreatitis (CP). METHODS From 1999 to 2010, 33 consecutive patients underwent Frey's procedure for CP in two centers. Seventeen (54%) patients underwent biliary bypass to treat an associated BO. Characteristics and outcomes of these patients were compared to those of 16 others without BO. RESULTS Patients with BO had more severe disease including lower BMI and larger pancreatic head (4 cm vs. 6 cm, p = 0.021). The operative mortality was nil. Patients with BO experienced more overall postoperative complications (71% vs. 31%, p = 0.024) but similar major complication rates (18% vs. 6%, p = 0.316) compared to those without BO. After a median follow-up of 51 (1-96) months, 91% of the patients experienced either partial or complete relief of their symptoms and 36% exhibited deterioration of their endocrine function. Multivariate analysis revealed preoperative BO to be associated with long-term impairment of endocrine function (OR: 43.249; 95% CI 2.221-84.277; p = 0.013). CONCLUSION In patients undergoing Frey's procedure for CP, associated BO can be safely managed using biliary bypass. However, the severity of CP in these patients is responsible for a higher risk of long-term endocrine insufficiency.
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Affiliation(s)
- F Cauchy
- Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France
| | - J M Regimbeau
- Department of Digestive Surgery, CHU Amiens-Picardie, Place Victor Pauchet, 80054 Amiens Cedex, France
| | - D Fuks
- Department of Digestive Surgery, CHU Amiens-Picardie, Place Victor Pauchet, 80054 Amiens Cedex, France
| | - P Balladur
- Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France
| | - E Tiret
- Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France
| | - F Paye
- Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France.
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Abstract
Surgery remains the only curative treatment for colorectal liver metastases. For patients with multiple bilobar spread, extended hepatectomy might be required to achieve complete margin-free resection. In such cases, portal vein occlusion has been developed to induce preoperative hypertrophy of the future remnant liver and increase the resectability rate. Evidence now suggests that liver regeneration after hepatectomy and portal vein occlusion has a protumorigenic role, either through an upregulation of growth factors and cytokines or by haemodynamic changes in the blood supply to the liver. Experimental studies have reported a stimulatory effect of liver regeneration on the tumoral volume of liver metastases and on the metastatic potential of cells engrafted in the liver; this effect seems to depend on the timing of hepatectomy and portal vein occlusion. However, the variability of animal tumour models that are used for research in experimental colorectal liver metastases might account for some of the inconsistent and conflicting results. This Review presents clinical and experimental data pertaining to whether liver regeneration causes proliferation of tumour cells. We also analyse the different animal models of colorectal liver metastases in use and discuss current controversies in the field.
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Affiliation(s)
- Chetana Lim
- Unité INSERM U965 (Université Paris 7), Angiogénèse et Recherche Translationnelle, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010 Paris, France
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Rouet J, Gaujoux S, Ronot M, Palazzo M, Cauchy F, Vilgrain V, Belghiti J, O'Toole D, Sauvanet A. Lemmel's syndrome as a rare cause of obstructive jaundice. Clin Res Hepatol Gastroenterol 2012; 36:628-31. [PMID: 22766153 DOI: 10.1016/j.clinre.2012.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 05/15/2012] [Indexed: 02/04/2023]
Abstract
Obstructive jaundice is a frequent symptom most frequently resulting from choledocolithiasis or pancreatico-biliary and periampullary tumors. If duodenal diverticula are frequently asymptomatic, they can occasionally present with obstructive jaundice in the absence of lithiasis or another obstructing lesion such as a tumor in a presentation called Lemmel's syndrome. We herein present a 70-year-old male with obstructive jaundice secondary to a periampullary duodenal diverticulum associated with hepatic abscess. Endoscopic sphincterotomy associated with percutaneous abscess drainage released patient from all symptoms. Lemmel's syndrome as a rare cause of obstructive jaundice should be known in order to avoid mismanagement and therapeutic delay.
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Affiliation(s)
- Jérémy Rouet
- Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif , AP-HP, Beaujon Hospital, Clichy, France
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Abstract
Surgery remains the best curative treatment for resectable patients with colorectal liver metastases. In patients initially considered unresectable, both refinements in surgical technique using portal vein occlusion or two-step resections and increased efficiency of chemotherapy regimen with the adjunction of antiangiogenics now allow secondary resection. Recent evidence suggests almost identical long-term survival in case of secondary downstaged lesions advocating an aggressive approach. However, these data lie on disparate and nonconsensual criteria for unresectability, which often do not gather technical and oncologic components together. Furthermore, both impaired general status and damaged underlying parenchyma as a consequence of prolonged chemotherapy to achieve resectability as well as the technical challenge required to perform adequate carcinologic resection could increase the operative risk in such patients. In our experience, a subgroup of slow chemo-responding initially unresectable patients who required preoperative liver volume modulation after ≥ 12 cycles of chemotherapy to achieve sufficient response experienced dramatically high operative risk which jeopardized postoperative chemotherapy and subsequently put these patients at increased risk of recurrence. Whether all patients preoperatively amenable to surgery using intensive chemotherapy and complex surgical strategy actually benefit from such an aggressive approach is a matter of ongoing debate, which needs a reappraisal.
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Affiliation(s)
- F Cauchy
- Department of Hepatobiliopancreatic Surgery, AP-HP, Beaujon Hospital and University Paris 7 Denis Diderot, Clichy, France
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Cauchy F, Zalinski S, Dokmak S, Fuks D, Farges O, Castera L, Paradis V, Belghiti J. Surgical treatment of hepatocellular carcinoma associated with the metabolic syndrome. Br J Surg 2012; 100:113-21. [PMID: 23147992 DOI: 10.1002/bjs.8963] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND The incidence of metabolic syndrome-associated hepatocellular carcinoma (MS-HCC) is increasing. However, the results following liver resection in this context have not been described in detail. METHODS Data for all patients with metabolic syndrome as a unique risk factor for HCC who underwent liver resection between 2000 and 2011 were retrieved retrospectively from an institutional database. Pathological analysis of the underlying parenchyma included fibrosis and non-alcoholic fatty liver disease activity score. Patients were classified as having normal or abnormal underlying parenchyma. Their characteristics and outcomes were compared. RESULTS A total of 560 resections for HCC were performed in the study interval. Sixty-two patients with metabolic syndrome, of median age 70 (range 50-84) years, underwent curative hepatectomy for HCC, including 32 major resections (52 per cent). Normal underlying parenchyma was present in 24 patients (39 per cent). The proportion of resected HCCs labelled as MS-HCC accounted for more than 15 per cent of the entire HCC population in more recent years. Mortality and major morbidity rates were 11 and 58 per cent respectively. Compared with patients with normal underlying liver, patients with abnormal liver had increased rates of mortality (0 versus 18 per cent; P = 0·026) and major complications (13 versus 42 per cent; P = 0·010). In multivariable analysis, a non-severely fibrotic yet abnormal underlying parenchyma was a risk factor for major complications (hazard ratio 5·66, 95 per cent confidence interval 1·21 to 26·52; P = 0·028). The 3-year overall and disease-free survival rates were 75 and 70 per cent respectively, and were not influenced by the underlying parenchyma. CONCLUSION HCC in patients with metabolic syndrome is becoming more common. Liver resection is appropriate but carries a high risk, even in the absence of severe fibrosis. Favourable long-term outcomes justify refinements in the perioperative management of these patients.
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Affiliation(s)
- F Cauchy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
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Cauchy F, Aussilhou B, Dokmak S, Fuks D, Farges O, Faivre SJ, Belghiti J. Reappraisal of the risks and benefits of major liver resection in patients with initially unresectable colorectal liver metastases. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3609 Background: Improvements in both surgical technique and efficacy of chemotherapy have increased the rate of resection for patients with initially unresectable colorectal liver metastases (IU-CRLM). We aimed to evaluate the short and long-term outcomes of major hepatectomy for such patients. Methods: From 2000 to 2011, 257 patients underwent major hepatectomy for CRLM. Seventy-eight (30%) of these patients were considered IU and required portal vein occlusion and/or ≥12 cycles or change in induction chemotherapy regimen to achieve resectability. Results: IU patients had respectively more lesions (5.6 vs.3.6, p=0.001), more frequently bilobar (70% vs.50% p=0.008) and synchronous (83.3% vs.70%, p=0.027) than initially resectable (IR) patients. Post-operative mortality (12.8% vs.1.7%, p=0.001) and major complications (46.2% vs.22.3%, p=0.0001) were higher in IU patients. An associated metabolic syndrome (HR 5.2, CI 1.2-21.9, p=0.025), high grade sinusoidal lesions (HR 2.4, CI 1.1-5.8, p=0.044) and the need for vascular reconstruction (HR 6.3, CI 1.2-34.4, p=0.032) were significant risk factors for major morbidity in IU patients. Significantly fewer IU patients received adjuvant chemotherapy in case of major postoperative complications compared to IR patients (47% vs. 83%, p=0.001). Overall 5-year survival was significantly lower in IU than in IR patients (26% vs.55%, p=0.032) and all IU patients had tumor recurrence within 3 years. The absence of adjuvant chemotherapy and tumor size ≥5 cm were the only factors associated with poor survival in multivariate analysis for IU patients. Conclusions: IU-CRLM patients requiring major liver resection displayed higher morbidity and mortality rates than IR ones, therefore compromising both short and long-term outcomes. Multimodal strategy should be reassessed in the presence of metabolic syndrome, sinusoidal lesions or major vascular involvement.
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Affiliation(s)
| | | | - Safi Dokmak
- HBP Surgery, Hôpital Beaujon, Clichy, France
| | - David Fuks
- HBP Surgery, Hôpital Beaujon, Clichy, France
| | | | - Sandrine J. Faivre
- Department of Medical Oncology, Beaujon University Hospital, Clichy, France
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Cauchy F, Fuks D, Belghiti J. HCC: current surgical treatment concepts. Langenbecks Arch Surg 2012; 397:681-95. [DOI: 10.1007/s00423-012-0911-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/17/2012] [Indexed: 12/28/2022]
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