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Kato H, Takada T, Strasberg S, Isaji S, Sano K, Yoshida M, Itoi T, Okamoto K, Kiriyama S, Yagi S, Matsubara T, Higuchi R, Ohyama T, Misawa T, Mukai S, Mori Y, Asai K, Mizuno S, Abe Y, Suzuki K, Homma Y, Hata J, Tsukiyama K, Kumamoto Y, Tsuyuguchi T, Maruo H, Asano Y, Hori S, Shibuya M, Mayumi T, Toyota N, Umezawa A, Gomi H, Horiguchi A. A multi-institutional study designed by members of Tokyo Guidelines (TG) Core Meeting to elucidate the clinical characteristics and pathogenesis of acute cholangitis after bilioenteric anastomosis and biliary stent insertion with a focus on biliary obstruction: Role of transient hepatic attenuation difference (THAD) and pneumobilia in improving TG diagnostic performance. J Hepatobiliary Pancreat Sci 2024; 31:12-24. [PMID: 37882430 DOI: 10.1002/jhbp.1368] [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] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND/PURPOSE The aim of this study was to clarify the clinical characteristics of acute cholangitis (AC) after bilioenteric anastomosis and stent-related AC in a multi-institutional retrospective study, and validate the TG18 diagnostic performance for various type of cholangitis. METHODS We retrospectively reviewed 1079 AC patients during 2020, at 16 Tokyo Guidelines 18 (TG 18) Core Meeting institutions. Of these, the post-biliary reconstruction associated AC (PBR-AC), stent-associated AC (S-AC) and common AC (C-AC) were 228, 307, and 544, respectively. The characteristics of each AC were compared, and the TG18 diagnostic performance of each was evaluated. RESULTS The PBR-AC group showed significantly milder biliary stasis compared to the C-AC group. Using TG18 criteria, definitive diagnosis rate in the PBR-AC group was significantly lower than that in the C-AC group (59.6% vs. 79.6%, p < .001) because of significantly lower prevalence of TG 18 imaging findings and milder bile stasis. In the S-AC group, the bile stasis was also milder, but definitive-diagnostic rate was significantly higher (95.1%) compared to the C-AC group. The incidence of transient hepatic attenuation difference (THAD) and pneumobilia were more frequent in PBR-AC than that in C-AC. The definitive-diagnostic rate of PBR-AC (59.6%-78.1%) and total cohort (79.6%-85.3%) were significantly improved when newly adding these items to TG18 diagnostic imaging findings. CONCLUSIONS The diagnostic rate of PBR-AC using TG18 is low, but adding THAD and pneumobilia to TG imaging criteria may improve TG diagnostic performance.
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Affiliation(s)
- Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Steven Strasberg
- Section of Hepatobiliary-Pancreatic and GI Surgery, Washington University, St. Louis, Missouri, USA
| | - Shuji Isaji
- Matsusaka City Hospital, Mie University, Tsu, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Ichikawa, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Surgery, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Shintaro Yagi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Takashi Matsubara
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yasuhisa Mori
- Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shugo Mizuno
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuta Abe
- Department of Surgery, Keio University, Tokyo, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Yuki Homma
- Department of Gastroenterological Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Jiro Hata
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Kana Tsukiyama
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepato-Biliary-Pancreatic Surgery, Kitasato University, Sagamihara, Japan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology, Chiba Prefectural Sawara Hospital, Katori, Japan
| | - Hirotoshi Maruo
- Department of Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University, Tokyo, Japan
| | - Makoto Shibuya
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Naoyuki Toyota
- Department of Surgery, Tsudanuma Central General Hospital, Narashino, Japan
| | - Akiko Umezawa
- Department of Surgery, Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Harumi Gomi
- International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
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Yamamoto M, Yoshida M, Furuse J, Sano K, Ohtsuka M, Yamashita S, Beppu T, Iwashita Y, Wada K, Nakajima TE, Sakamoto K, Hayano K, Mori Y, Asai K, Matsuyama R, Hirashita T, Hibi T, Sakai N, Tabata T, Kawakami H, Takeda H, Mizukami T, Ozaka M, Ueno M, Naito Y, Okano N, Ueno T, Hijioka S, Shikata S, Ukai T, Strasberg S, Sarr MG, Jagannath P, Hwang TL, Han HS, Yoon YS, Wang HJ, Luo SC, Adam R, Gimenez M, Scatton O, Oh DY, Takada T. Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021. J Hepatobiliary Pancreat Sci 2020; 28:1-25. [PMID: 33200538 DOI: 10.1002/jhbp.868] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato-Biliary-Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors. METHODS Eight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. RESULTS The eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two. A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy. CONCLUSIONS These guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher-quality evidence.
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Affiliation(s)
- Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Ichikawa, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Yamashita
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.,Kyoto Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Ryusei Matsuyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokoama, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Nozomu Sakai
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisato Kawakami
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Hiroyuki Takeda
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masato Ozaka
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Ueno
- Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoichi Naito
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naohiro Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Takayuki Ueno
- Breast Surgical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Tomohiko Ukai
- Division of Public Health, Osaka Institute of Public Health, Higashinari, Japan
| | - Steven Strasberg
- Section of HPB Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - Tsann-Long Hwang
- Division of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Seong Han
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Seok Yoon
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Shao-Ciao Luo
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - René Adam
- AP HP Paul Brousse Hospital, University Paris Sud, Villejuif, France
| | - Mariano Gimenez
- Docencia Asistencia Investigación en Cirugía Invasiva Mínima Foundation, General and Minimally Invasive Surgery, University of Buenos Aires, Viamonte, Argentina.,Institute of Image-Guided Surgery, Strasbourg, France
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, APHP Pitié-Salpêtrière Hospital, Sorbonne Université, CRSA, Paris, France
| | - Do-Youn Oh
- Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Rudra S, Brenneman R, Badiyan S, Wang-Gillam A, Hawkins W, Fields R, Strasberg S, Roach M, Kim H. PV-0624 pathologic response in pancreatic cancer treated with neoadjuvant MRI-guided radiation therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31044-8] [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: 11/29/2022]
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4
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Cho M, Wang-Gillam A, Myerson R, Gao F, Strasberg S, Picus J, Sorscher S, Fournier C, Nagaraj G, Parikh P, Suresh R, Linehan D, Tan BR. A phase II study of adjuvant gemcitabine plus docetaxel followed by concurrent chemoradation in resected pancreaticobiliary carcinoma. HPB (Oxford) 2015; 17:587-93. [PMID: 25800066 PMCID: PMC4474505 DOI: 10.1111/hpb.12413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 12/08/2014] [Accepted: 02/17/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Adjuvant gemcitabine with or without chemoradiation is a standard therapeutic option for patients with resected pancreatic cancer. The feasibility and toxicity of gemcitabine with docetaxel before and after 5-fluorouracil (5FU)-based chemoradiation in the adjuvant pancreatic and biliary cancer setting were investigated. METHODS After a curative-intent resection, eligible patients with pancreaticobiliary cancers were treated with two cycles of gemcitabine and docetaxel followed by 5FU-based chemoradiation. Four weeks after completing chemoradiation, two cycles of gemcitabine and docetaxel were administered. The primary endpoint was the incidence of severe toxicities. Secondary endpoints included disease-free survival (DFS) and overall survival (OS). RESULTS Fifty patients with pancreaticobiliary cancers were enrolled. Twenty-nine patients had pancreatic cancer whereas 21 patients had biliary tract or ampullary cancers. There was one death as a result of pneumonia, and 15% of patients experienced grade 3 or greater non-haematological toxicities. The median DFS and OS for patients with pancreatic cancer were 9.6 and 17 months, respectively, and for those with resected biliary tract cancer were 12 and 23 months, respectively. CONCLUSIONS This combination of gemcitabine and docetaxel with chemoradiation is feasible and tolerable in the adjuvant setting. Future studies utilizing a different gemcitabine/taxane combination and schedule may be appropriate in the adjuvant treatment of both pancreatic cancer and biliary tumours.
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Affiliation(s)
- May Cho
- Department of Medicine, Washington University School of MedicineSt. Louis, MO, USA
| | - Andrea Wang-Gillam
- Department of Medicine, Washington University School of MedicineSt. Louis, MO, USA
| | - Robert Myerson
- Department of Radiation Oncology, Washington University School of MedicineSt. Louis, MO, USA
| | - Feng Gao
- Division of Biostatistics, Washington University School of MedicineSt. Louis, MO, USA
| | - Steven Strasberg
- Department of Surgery, Washington University School of MedicineSt. Louis, MO, USA
| | - Joel Picus
- Department of Medicine, Washington University School of MedicineSt. Louis, MO, USA
| | - Steven Sorscher
- Department of Medicine, Washington University School of MedicineSt. Louis, MO, USA
| | - Chloe Fournier
- Department of Medicine, Washington University School of MedicineSt. Louis, MO, USA
| | - Gayathri Nagaraj
- Division of Medical Oncology and Hematology, Loma Linda UniversityLoma Linda, CA, USA
| | - Parag Parikh
- Department of Radiation Oncology, Washington University School of MedicineSt. Louis, MO, USA
| | - Rama Suresh
- Department of Medicine, Washington University School of MedicineSt. Louis, MO, USA
| | - David Linehan
- Department of Surgery, Washington University School of MedicineSt. Louis, MO, USA
| | - Benjamin R Tan
- Department of Medicine, Washington University School of MedicineSt. Louis, MO, USA
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5
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Strasberg S. Physicians lead reform. CMAJ 2010; 182:482. [DOI: 10.1503/cmaj.110-2034] [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: 11/01/2022] Open
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Kanter J, Wilson DB, Strasberg S. Downsizing to resectability of a large solid and cystic papillary tumor of the pancreas by single-agent chemotherapy. J Pediatr Surg 2009; 44:e23-5. [PMID: 19853735 DOI: 10.1016/j.jpedsurg.2009.07.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [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: 05/20/2009] [Revised: 07/07/2009] [Accepted: 07/09/2009] [Indexed: 12/13/2022]
Abstract
Solid and cystic pseudopapillary tumor (SCPT) is an uncommon cancer that typically affects young women. Most patients with SCPT have a favorable prognosis provided a complete resection is attained. There are anecdotal reports of the use of neoadjuvant chemotherapy or radiation therapy for patients with unresectable tumors. We report the case of a 14-year-old female with SCPT who was successfully downsized with gemcitabine before definitive surgical resection.
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Affiliation(s)
- Julie Kanter
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
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Tsuyuguchi T, Takada T, Kawarada Y, Nimura Y, Wada K, Nagino M, Mayumi T, Yoshida M, Miura F, Tanaka A, Yamashita Y, Hirota M, Hirata K, Yasuda H, Kimura Y, Strasberg S, Pitt H, Büchler MW, Neuhaus H, Belghiti J, de Santibanes E, Fan ST, Liau KH, Sachakul V. Techniques of biliary drainage for acute cholangitis: Tokyo Guidelines. ACTA ACUST UNITED AC 2007; 14:35-45. [PMID: 17252295 PMCID: PMC2784512 DOI: 10.1007/s00534-006-1154-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 02/08/2023]
Abstract
Biliary decompression and drainage done in a timely manner is the cornerstone of acute cholangitis treatment. The mortality rate of acute cholangitis was extremely high when no interventional procedures, other than open drainage, were available. At present, endoscopic drainage is the procedure of first choice, in view of its safety and effectiveness. In patients with severe (grade III) disease, defined according to the severity assessment criteria in the Guidelines, biliary drainage should be done promptly with respiration management, while patients with moderate (grade II) disease also need to undergo drainage promptly with close monitoring of their responses to the primary care. For endoscopic drainage, endoscopic nasobiliary drainage (ENBD) or stent placement procedures are performed. Randomized controlled trials (RCTs) have reported no difference in the drainage effect of these two procedures, but case-series studies have indicated the frequent occurrence of hemorrhage associated with endoscopic sphincterotomy (EST), and complications such as pancreatitis. Although the usefulness of percutaneous transhepatic drainage is supported by the case-series studies, its lower success rate and higher complication rates makes it a second-option procedure.
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Affiliation(s)
- Toshio Tsuyuguchi
- Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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Tsuyuguchi T, Takada T, Kawarada Y, Nimura Y, Wada K, Nagino M, Mayumi T, Yoshida M, Miura F, Tanaka A, Yamashita Y, Hirota M, Hirata K, Yasuda H, Kimura Y, Neuhaus H, Strasberg S, Pitt H, Belghiti J, Belli G, Windsor JA, Chen MF, Kim SW, Dervenis C. Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. ACTA ACUST UNITED AC 2007; 14:46-51. [PMID: 17252296 PMCID: PMC2784517 DOI: 10.1007/s00534-006-1155-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 12/19/2022]
Abstract
The principal management of acute cholecystitis is early cholecystectomy. However, percutaneous transhepatic gallbladder drainage (PTGBD) may be preferable for patients with moderate (grade II) or severe (grade III) acute cholecystitis. For patients with moderate (grade II) disease, PTGBD should be applied only when they do not respond to conservative treatment. For patients with severe (grade III) disease, PTGBD is recommended with intensive care. Percutaneous transhepatic gallbladder aspiration (PTGBA) is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. To clarify the clinical value of these drainage methods, proper randomized trials should be done. This article describes techniques of drainage for acute cholecystitis.
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Affiliation(s)
- Toshio Tsuyuguchi
- Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
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9
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Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, Mayumi T, Yoshida M, Strasberg S, Pitt HA, de Santibanes E, Belghiti J, Büchler MW, Gouma DJ, Fan ST, Hilvano SC, Lau JWY, Kim SW, Belli G, Windsor JA, Liau KH, Sachakul V. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. ACTA ACUST UNITED AC 2007; 14:91-7. [PMID: 17252302 PMCID: PMC2784499 DOI: 10.1007/s00534-006-1161-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 12/12/2022]
Abstract
Cholecystectomy has been widely performed in the treatment of acute cholecystitis, and laparoscopic cholecystectomy has been increasingly adopted as the method of surgery over the past 15 years. Despite the success of laparoscopic cholecystectomy as an elective treatment for symptomatic gallstones, acute cholecystitis was initially considered a contraindication for laparoscopic cholecystectomy. The reasons for it being considered a contraindication were the technical difficulty of performing it in acute cholecystitis and the development of complications, including bile duct injury, bowel injury, and hepatic injury. However, laparoscopic cholecystectomy is now accepted as being safe for acute cholecystitis, when surgeons who are expert at the laparoscopic technique perform it. Laparoscopic cholecystectomy has been found to be superior to open cholecystectomy as a treatment for acute cholecystitis because of a lower incidence of complications, shorter length of postoperative hospital stay, quicker recuperation, and earlier return to work. However, laparoscopic cholecystectomy for acute cholecystitis has not become routine, because the timing and approach to the surgical management in patients with acute cholecystitis is still a matter of controversy. These Guidelines describe the timing of and the optimal surgical treatment of acute cholecystitis in a question-and-answer format.
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Affiliation(s)
- Yuichi Yamashita
- Department of Surgery, Fukuoka University Hospital, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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Sekimoto M, Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Miura F, Wada K, Hirota M, Yamashita Y, Strasberg S, Pitt HA, Belghiti J, de Santibanes E, Gadacz TR, Hilvano SC, Kim SW, Liau KH, Fan ST, Belli G, Sachakul V. Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo Guidelines. ACTA ACUST UNITED AC 2007; 14:11-4. [PMID: 17252292 PMCID: PMC2784506 DOI: 10.1007/s00534-006-1151-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 11/29/2022]
Abstract
The Tokyo Guidelines formulate clinical guidance for healthcare providers regarding the diagnosis, severity assessment, and treatment of acute cholangitis and acute cholecystitis. The Guidelines were developed through a comprehensive literature search and selection of evidence. Recommendations were based on the strength and quality of evidence. Expert consensus opinion was used to enhance or formulate important areas where data were insufficient. A working group, composed of gastroenterologists and surgeons with expertise in biliary tract surgery, supplemented with physicians in critical care medicine, epidemiology, and laboratory medicine, was selected to formulate draft guidelines. Several other groups (including members of the Japanese Society for Abdominal Emergency Medicine, the Japan Biliary Association, and the Japanese Society of Hepato-Biliary-Pancreatic Surgery) have reviewed and revised the draft guidelines. To build a global consensus on the management of acute biliary infection, an international expert panel, representing experts in this area, was established. Between April 1 and 2, 2006, an International Consensus Meeting on acute biliary infections was held in Tokyo. A consensus was determined based on best available scientific evidence and discussion by the panel of experts. This report describes the highlights of the Tokyo International Consensus Meeting in 2006. Some important areas focused on at the meeting include proposals for internationally accepted diagnostic criteria and severity assessment for both clinical and research purposes.
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Affiliation(s)
- Miho Sekimoto
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Konoe-cho, Yoshida, Sakyo-ku, Kyoto, 606-8501, Japan
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Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, Mayumi T, Strasberg S, Pitt HA, Gadacz TR, Büchler MW, Belghiti J, de Santibanes E, Gouma DJ, Neuhaus H, Dervenis C, Fan ST, Chen MF, Ker CG, Bornman PC, Hilvano SC, Kim SW, Liau KH, Kim MH. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. ACTA ACUST UNITED AC 2007; 14:52-8. [PMID: 17252297 PMCID: PMC2784515 DOI: 10.1007/s00534-006-1156-7] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 12/11/2022]
Abstract
Because acute cholangitis sometimes rapidly progresses to a severe form accompanied by organ dysfunction, caused by the systemic inflammatory response syndrome (SIRS) and/or sepsis, prompt diagnosis and severity assessment are necessary for appropriate management, including intensive care with organ support and urgent biliary drainage in addition to medical treatment. However, because there have been no standard criteria for the diagnosis and severity assessment of acute cholangitis, practical clinical guidelines have never been established. The aim of this part of the Tokyo Guidelines is to propose new criteria for the diagnosis and severity assessment of acute cholangitis based on a systematic review of the literature and the consensus of experts reached at the International Consensus Meeting held in Tokyo 2006. Acute cholangitis can be diagnosed if the clinical manifestations of Charcot's triad, i.e., fever and/or chills, abdominal pain (right upper quadrant or epigastric), and jaundice are present. When not all of the components of the triad are present, then a definite diagnosis can be made if laboratory data and imaging findings supporting the evidence of inflammation and biliary obstruction are obtained. The severity of acute cholangitis can be classified into three grades, mild (grade I), moderate (grade II), and severe (grade III), on the basis of two clinical factors, the onset of organ dysfunction and the response to the initial medical treatment. "Severe (grade III)" acute cholangitis is defined as acute cholangitis accompanied by at least one new-onset organ dysfunction. "Moderate (grade II)" acute cholangitis is defined as acute cholangitis that is unaccompanied by organ dysfunction, but that does not respond to the initial medical treatment, with the clinical manifestations and/or laboratory data not improved. "Mild (grade I)" acute cholangitis is defined as acute cholangitis that responds to the initial medical treatment, with the clinical findings improved.
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Affiliation(s)
- Keita Wada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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Yoshida M, Takada T, Kawarada Y, Tanaka A, Nimura Y, Gomi H, Hirota M, Miura F, Wada K, Mayumi T, Solomkin JS, Strasberg S, Pitt HA, Belghiti J, de Santibanes E, Fan ST, Chen MF, Belli G, Hilvano SC, Kim SW, Ker CG. Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines. ACTA ACUST UNITED AC 2007; 14:83-90. [PMID: 17252301 PMCID: PMC2784497 DOI: 10.1007/s00534-006-1160-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 01/28/2023]
Abstract
Acute cholecystitis consists of various morbid conditions, ranging from mild cases that are relieved by the oral administration of antimicrobial drugs or that resolve even without antimicrobials to severe cases complicated by biliary peritonitis. Microbial cultures should be performed by collecting bile at all available opportunities to identify both aerobic and anaerobic organisms. Empirically selected antimicrobials should be administered. Antimicrobial activity against potential causative organisms, the severity of the cholecystitis, the patient’s past history of antimicrobial therapy, and local susceptibility patterns (antibiogram) must be taken into consideration in the choice of antimicrobial drugs. In mild cases which closely mimic biliary colic, the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended to prevent the progression of inflammation (recommendation grade A). When causative organisms are identified, the antimicrobial drug should be changed for a narrower-spectrum antimicrobial agent on the basis of the species and their susceptibility testing results.
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Affiliation(s)
- Masahiro Yoshida
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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13
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Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, Mayumi T, Yoshida M, Strasberg S, Pitt H, Gadacz TR, de Santibanes E, Gouma DJ, Solomkin JS, Belghiti J, Neuhaus H, Büchler MW, Fan ST, Ker CG, Padbury RT, Liau KH, Hilvano SC, Belli G, Windsor JA, Dervenis C. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. ACTA ACUST UNITED AC 2007; 14:78-82. [PMID: 17252300 PMCID: PMC2784516 DOI: 10.1007/s00534-006-1159-4] [Citation(s) in RCA: 263] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 12/11/2022]
Abstract
The aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of acute cholecystitis and extracted the best current available evidence. In addition to the evidence and face-to-face discussions, domestic consensus meetings were held by the experts in order to assess the results. A provisional outcome statement regarding the diagnostic criteria and criteria for severity assessment was discussed and finalized during an International Consensus Meeting held in Tokyo 2006. Patients exhibiting one of the local signs of inflammation, such as Murphy’s sign, or a mass, pain or tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell count, and elevated C-reactive protein level, are diagnosed as having acute cholecystitis. Patients in whom suspected clinical findings are confirmed by diagnostic imaging are also diagnosed with acute cholecystitis. The severity of acute cholecystitis is classified into three grades, mild (grade I), moderate (grade II), and severe (grade III). Grade I (mild acute cholecystitis) is defined as acute cholecystitis in a patient with no organ dysfunction and limited disease in the gallbladder, making cholecystectomy a low-risk procedure. Grade II (moderate acute cholecystitis) is associated with no organ dysfunction but there is extensive disease in the gallbladder, resulting in difficulty in safely performing a cholecystectomy. Grade II disease is usually characterized by an elevated white blood cell count; a palpable, tender mass in the right upper abdominal quadrant; disease duration of more than 72 h; and imaging studies indicating significant inflammatory changes in the gallbladder. Grade III (severe acute cholecystitis) is defined as acute cholecystitis with organ dysfunction.
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Affiliation(s)
- Masahiko Hirota
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
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14
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Bilchik AJ, Rosen LS, Poston G, Curley SA, Strasberg S, Saltz L, Adam R, Nordlinger B, Rougier P. In Reply:. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.05.7232] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anton J. Bilchik
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
| | - Lee S. Rosen
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
| | - Graeme Poston
- Royal Liverpool and Aintree University Hospitals, Liverpool, United Kingdom
| | - Steven A. Curley
- The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Steven Strasberg
- Siteman Cancer Center at Washington University in Saint Louis, St Louis, MO
| | - Leonard Saltz
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Rene Adam
- Paul Brousse Hospital, Paris, France
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Bilchik AJ, Poston G, Curley SA, Strasberg S, Saltz L, Adam R, Nordlinger B, Rougier P, Rosen LS. Neoadjuvant chemotherapy for metastatic colon cancer: a cautionary note. J Clin Oncol 2006; 23:9073-8. [PMID: 16361615 DOI: 10.1200/jco.2005.03.2334] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Anton J Bilchik
- John Wayne Cancer Institute at St John's Health Center, Santa Monica, CA, USA
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17
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Barkun J, Dixon E, Strasberg S. Canadian Association of General Surgeons and American College of Surgeons evidence based reviews in surgery. 13. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones. Can J Surg 2005; 48:244-6. [PMID: 16013632 PMCID: PMC3211555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
- Jeffrey Barkun
- CAGS-EBRS, Mount Sinai Hospital, 1560-600 University Ave., Toronto, ON M5G 1X5
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18
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Cleary SP, Gryfe R, Guindi M, Greig P, Smith L, Mackenzie R, Strasberg S, Hanna S, Taylor B, Langer B, Gallinger S. Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. J Am Coll Surg 2004; 198:722-31. [PMID: 15110805 DOI: 10.1016/j.jamcollsurg.2004.01.008] [Citation(s) in RCA: 253] [Impact Index Per Article: 12.7] [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: 03/21/2003] [Revised: 01/14/2004] [Accepted: 01/14/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatic cancer is a rapidly fatal disease with very few 5-year survivors even after aggressive surgical treatment. Our objective was to determine the actual 5-year survival rate of patients with pancreatic adenocarcinoma who underwent a resection with curative intent in 5 teaching hospitals within the University of Toronto system. We then sought to determine clinical and histopathologic features of 5-year survivors to determine factors associated with a favorable prognosis. STUDY DESIGN A retrospective chart review was performed using surgeon and hospital databases to identify patients who had a surgical resection for pancreatic adenocarcinoma between January 1, 1988, and December 31, 1996. RESULTS One hundred twenty-three patients who had a resection and a pathologic diagnosis of pancreatic adenocarcinoma with complete followup were identified from seven surgical practices. Mean survival (+/- standard error) in this series was 31.7 +/- 3.5 months (median 13.6 months). There were 18 5-year survivors (14.6%), including 5 patients (4.1%) who survived longer than 10 years. The survivors included 13 patients who had undergone a Whipple resection, 4 who had undergone a distal pancreatectomy, and 1 who had undergone a total pancreatectomy. Tumor size, lack of jaundice at presentation, negative nodal disease, low tumor grade, and a low tumor stage were all significant predictors of survival in univariate analysis (all p < 0.05). Only tumor stage (hazard ratio [95% confidence interval]: stage IIA 1.5 [0.8 to 2.8], stage IIB 2.6 [1.4 to 4.7], stage III 1.8 [0.8 to 4.3]) and tumor grade (hazard ratio [95% confidence interval]: moderately differentiated 1.6 [0.9 to 2.9], and poorly differentiated 3.1 [1.6 to 6.2]) were independently associated with survival differences in a multivariate Cox proportional hazards model. CONCLUSIONS We conclude that longterm survival from pancreatic adenocarcinoma is possible if the disease is identified in its early stages. These and other similar data should provide further stimulus for the development and evaluation of novel screening strategies to improve early detection of this disease.
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Affiliation(s)
- Sean P Cleary
- Department of Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 2X5
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Deleve LD, Wang X, Tsai J, Kanel G, Strasberg S, Tokes ZA. Sinusoidal obstruction syndrome (veno-occlusive disease) in the rat is prevented by matrix metalloproteinase inhibition. Gastroenterology 2003; 125:882-90. [PMID: 12949732 DOI: 10.1016/s0016-5085(03)01056-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The mechanical origins of the obstruction in sinusoidal obstruction syndrome are initiated by dehiscence of sinusoidal endothelial cells from the space of Disse. The biochemical changes that permit the dehiscence of the sinusoidal endothelial cells were investigated. METHODS In vitro and in vivo studies examined changes induced by monocrotaline, a pyrrolizidine alkaloid that induces sinusoidal obstruction syndrome in both humans and experimental animals. RESULTS In the monocrotaline-induced rat model of sinusoidal obstruction syndrome, there was an early increase of matrix metalloproteinase-9 and a later, lower-magnitude increase of matrix metalloproteinase-2 in the liver. In vitro studies of sinusoidal endothelial cells, hepatocytes, stellate cells, and Kupffer cells showed that sinusoidal endothelial cells are the major source of both basal and monocrotaline-induced matrix metalloproteinase-9/matrix metalloproteinase-2 activity. Monocrotaline caused depolymerization of F-actin in sinusoidal endothelial cells, and blocking of F-actin depolymerization prevented the increase in matrix metalloproteinase activity. Administration of matrix metalloproteinase inhibitors prevented the signs and histological changes associated with sinusoidal obstruction syndrome. CONCLUSIONS Monocrotaline causes depolymerization of F-actin in sinusoidal endothelial cells, which leads to increased expression of metalloproteinase-9 and matrix metalloproteinase-2 by sinusoidal endothelial cells. Inhibition of matrix metalloproteinase-9 and matrix metalloproteinase-2 prevents the development of sinusoidal obstruction syndrome, establishing that matrix metalloproteinase inhibitors may be a therapeutically viable strategy for prevention.
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Affiliation(s)
- Laurie D Deleve
- Division of Gastrointestinal and Liver Disease, University of Southern California Keck School of Medicine, Los angeles, California 90033, USA.
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21
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Myerson R, Thorstad W, Solis J, Picus J, Drebin J, Linehan D, Strasberg S. Alternating cycles of full dose split course radiation therapy and gemcitabine chemotherapy for unresectable pancreatic carcinoma. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03419-3] [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: 10/27/2022]
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22
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Asano TK, McLeod RS, Blitz M, Butts C, Kneteman N, Bigam D, Oosthuizen JFM, Phang PT, Gouthro D, Ravid A, Liu M, O'Connor BI, MacRae HM, Cohen Z, McLeod RS, Al-Obeed O, Penning J, Stern HS, Colquhoun P, Nogueras J, Dipasquale B, Petras J, Wexner S, Woodhouse S, Raval MJ, Heine JA, May GR, Bass S, Brown CJ, MacLean AR, Asano T, Cohen Z, MacRae HM, O'Connor BI, McLeod RS, Asano TK, Toma D, Stern HS, McLeod RS, Irshad K, Ghitulescu GA, Gordon PH, MacLean AR, Lilly L, Cohen Z, O'Connor B, McLeod RS, Ravid A, O'Connor BI, Liu M, MacRae HM, Cohen Z, McLeod RS, St Germaine RL, de Gara CJ, Fox R, Kenwell Z, Blitz S, Wong JT, Mc-Mulkin HM, Porter GA, Jayaraman S, Gray D, Burpee SE, Schlachta CM, Mamazza J, Pace K, Poulin EC, Freeman J, Tranqui P, Trottier D, Bodurtha A, Sarma A, Bheerappa N, Sastry RA, de Gara CJ, Hanson J, Hamilton S, Taylor MC, Haase E, Stevens J, Rigo V, Richards J, Bigam DL, Cheung PY, Burpee SE, Schlachta CM, Mamazza J, Pace K, Poulin EC, Grace DM, Gupta S, Sarma A, Bheerappa N, Radhakrishna P, Sastry RA, Malik S, Duffy P, Schulte P, Cameron R, Pace KT, Dyer S, Phan V, Poulin E, Schlachta C, Mamazza J, Stewart R, Honey RJ, Kanthan R, Kanthan SC, Jayaraman S, Aarts MA, Solomon MJ, McLeod RS, Ong S, Pitt D, Stephen W, Latulippe J, Girotti M, Bloom S, Pace K, Dyer S, Stewart R, Honey RJ, Poulin E, Schlachta C, Mamazza J, Furlan JC, Rosen IB, Asano TK, Haigh PI, McLeod RS, Al Saleh N, Taylor B, Karimuddin AA, Marschall J, McFadden A, Pollett WG, Dicks E, Tranqui P, Trottier D, Freeman J, Bodurtha A, Urbach DR, Bell CM, Austin PC, Cleary SP, Gyfe R, Greig P, Smith L, Mackenzie R, Strasberg S, Hanna S, Taylor B, Langer B, Gallinger S, Marschall J, Nechala P, Chibbar R, Colquhoun P, Zhou J, Lee TDG, Meneghetti AT, McKenna GJ, Owen D, Scudamore CH, McMaster RM, Chung SW, Aarts MA, Granton J, Cook DJ, Bohnen JMA, Marshall JC, Colquhoun P, Weiss E, Efron J, Nogueras J, Vernava A, Wexner S, Poulin EC, Schlachta CM, Burpee SE, Pace KT, Mamazza J, Rosen IB, Furlan JC, Charghi R, Schricker T, Backman S, Rouah F, Christou NV, Obayan A, Keith R, Juurlink BHJ, Skaro AI, Liwski RS, Zhou J, Lee TDG, Hirsch GM, Powers KA, Khadaroo RG, Papia G, Kapus A, Rotstein OD, Furlan JC, Rosen IB, Stratford AFC, George RL, VanManen L, Klassen DR, Feldman LS, Mayrand S, Mercier L, Stanbridge D, Fried GM, Nanji SA, Hancock WW, Anderson C, Shapiro AMJ, Butter A, Martins L, Taylor B, Ott MC, Rycroft K, Wall WJ, Burpee SE, Schlachta CM, Mamazza J, Pace K, Poulin EC, Taylor MC, Christou NV, Jarand J, Sylvestre JL, McLean APH, Behzadi A, Tan L, Unruh H, Brandt MG, Darling GE, Miller L, Seely AJE, Maziak DE, Gunning D, Do MT, Bukhari M, Shamji FM, Abdurahman A, Darling G, Ginsberg R, Johnston M, Waddell T, Keshavjee S, Cuccarolo G, Charyk-Stewart T, Inaba K, Malthaner R, Gray D, Girotti M, Grondin SC, Tutton SM, Sichlau MJ, Pozdol C, McDonough TJ, Masters GA, Ray DW, Liptay MJ. Abstracts of presentations to the Annual Meetings of the Canadian Society of Colon and Rectal Surgeons Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons: Canadian Surgery Forum, London, Ont., Sept. 19 to 22, 2002. Can J Surg 2002; 45:3-26. [PMID: 37381180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - D Pitt
- Ottawa Hospital, University of Ottawa, Ottawa, Ont
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Abstract
Currently, several strains of rats are used for studies of peripheral-nerve injury and repair. The purpose of this study was to determine if significant differences in regeneration between strains exist that might influence comparison of results and interpretation of scientific conclusions. One outbred (Sprague-Dawley) and four inbred stains (ACI, Wistar-Furth, Lewis, Brown-Norway) were studied. Animals were randomized to one of two experimental conditions, undergoing either posterior tibial nerve transection and repair, or Silastic conduit repair of the posterior tibial nerve (n=6/group). Endpoint evaluations at 6 and 13 weeks included histomorphometry and walking-track analysis. Evidence of excellent regeneration was noted in all rat strains undergoing primary repair. Generally, no statistically significant differences between strains were noted, regardless of endpoint evaluation used in the primary repair group. Nerve regeneration across the conduits was either poor or not present at 6 weeks, with no regeneration at all noted in any animals in the ACI and Brown-Norway groups, and regeneration in only one or two animals in the other strains. At 13 weeks, between three and five animals in each strain showed regeneration, but functional recovery was poor. Overall, few differences in peripheral-nerve recovery appear to exist between rat strains. It seems that uniform conclusions may be drawn regardless of strain used.
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Affiliation(s)
- J E Strasberg
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
Acute cholecystitis is increasingly managed by laparoscopic cholecystectomy. Some reports have shown conversion and complication rates that are increased in comparison to elective laparoscopic cholecystectomy. This study reviews the combined experience of two hospitals where the intention was to perform early laparoscopic cholecystectomy for acute cholecystitis. A total of 152 cases of laparoscopic cholecystectomy for acute cholecystitis (evidence of acute inflammation clinically and pathologically) were identified. Conversion to open cholecystectomy was required in 14 cases (9%) in the total series. Laparoscopic cholecystectomy was performed within 2 days of admission in 76% (115 of 152) of patients. Conversion was significantly less likely in patients undergoing laparoscopic cholecystectomy within 2 days of admission (4 of 115) compared to those undergoing surgery beyond 2 days (10 of 37; P<0.0001). Eleven patients (7%) had postoperative complications; however, there were no cases of injury to the biliary system and no perioperative deaths. This series shows that laparoscopic cholecystectomy can be performed safely in patients with acute cholecystitis and suggests that early laparoscopic cholecystectomy is preferable to delaying surgery. Although the conversion rate to open surgery is higher than for elective cholecystectomy, the majority of patients (91%) still derive the well-recognized benefits of laparoscopic cholecystectomy. Early laparoscopic cholecystectomy is an acceptable approach to acute cholecystitis for the experienced laparoscopic surgeon.
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Abstract
Ideal reconstruction of the oral cavity includes a durable lining that is thin, supple, and innervated, and that provides a lubricated surface that facilitates deglutition and speech. This paper describes the use of free colon transfer for relining the oral cavity. In three patients, segments of transverse colon, split along the antimesenteric border, were transferred as free flaps on the middle colic vessels for large defects involving the alveolar ridge, buccal mucosa, floor of the mouth, tongue, and pharyngeal walls. All flaps were transferred successfully without adverse vascular events, abdominal complications, or oro-cutaneous fistulas. One flap was re-elevated 2 weeks postoperatively for additional mandibulectomy. Two patients received postoperative radiation therapy and another patient received planned preoperative radiotherapy. The mucosal surface of the colon flattens to provide a thin, smooth, supple oral lining that produces moderate mucus, coapts well to the convoluted surfaces of the defects, and is durable to mastication and denture wear. Mucosal biopsy 2 years postoperatively in the nonradiated flap reveals normal colon mucosa with abundant mucin-producing cells. Free colon transfer is a "functional" reconstruction of the oral lining. The donor tissue is abundant and capable of resurfacing large, convoluted oral cavity surfaces with a thin, supple, mucus-secreting tissue that allows unimpaired tongue mobility, swallowing, speech, and denture wear. Furthermore, the presence of nonirradiated, mucus-secreting cells provides an avenue to further augment mucin production by topical and systemic agents.
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Affiliation(s)
- T R Jones
- Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Mo., USA
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26
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Abstract
The Sugiura procedure for esophageal varices combines splenectomy with esophagogastric devascularization, which destroys the intraesophageal portacaval shunt but preserves periesophageal portacaval shunts. We have modified the total vagotomy and pyloroplasty and sutured esophageal anastomosis of the original operation. A single left thoracoabdominal incision is used. Esophagogastric devascularization is performed without dividing the main vagus trunks; only a proximal gastric vagotomy is done, thereby avoiding a pyloroplasty. The esophageal transection and reanastomosis are performed with the circular End-to-End Anastomosis stapler and protected with a loose-fundal wrap. Fifteen of 20 patients have had good to excellent results, with rapid recovery and no recurrent esophagogastric bleeding or any hepatic encephalopathy in follow-up of two months to two years. Four patients, who were bleeding massively at the time of operation and who were in Child's class C with gross ascites, muscle wasting, ad coagulopathy, died in the postoperative period. Conceptually, the operation is original and exciting because it preserves hepatic blood flow and the beneficial periesophageal shunt, while destroying the harmful intraesophageal shunt. Our early experience encourages us to continue using this operation, except in those patients who bleed massively and are in Child's C, end-stage, class.
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