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Arntz PJW, Deroose CM, Marcus C, Sturesson C, Panaro F, Erdmann J, Manevska N, Moadel R, de Geus-Oei LF, Bennink RJ. Joint EANM/SNMMI/IHPBA procedure guideline for [ 99mTc]Tc-mebrofenin hepatobiliary scintigraphy SPECT/CT in the quantitative assessment of the future liver remnant function. HPB (Oxford) 2023; 25:1131-1144. [PMID: 37394397 DOI: 10.1016/j.hpb.2023.06.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE The aim of this joint EANM/SNMMI/IHPBA procedure guideline is to provide general information and specific recommendations and considerations on the use of [99mTc]Tc-mebrofenin hepatobiliary scintigraphy (HBS) in the quantitative assessment and risk analysis before surgical intervention, selective internal radiation therapy (SIRT) or before and after liver regenerative procedures. Although the gold standard to estimate future liver remnant (FLR) function remains volumetry, the increasing interest in HBS and the continuous request for implementation in major liver centers worldwide, demands standardization. METHODS This guideline concentrates on the endorsement of a standardized protocol for HBS elaborates on the clinical indications and implications, considerations, clinical appliance, cut-off values, interactions, acquisition, post-processing analysis and interpretation. Referral to the practical guidelines for additional post-processing manual instructions is provided. CONCLUSION The increasing interest of major liver centers worldwide in HBS requires guidance for implementation. Standardization facilitates applicability of HBS and promotes global implementation. Inclusion of HBS in standard care is not meant as substitute for volumetry, but rather to complement risk evaluation by identifying suspected and unsuspected high-risk patients prone to develop post-hepatectomy liver failure (PHLF) and post-SIRT liver failure.
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Affiliation(s)
- Pieter J W Arntz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands.
| | - Christophe M Deroose
- Nuclear Medicine, University Hospitals Leuven, Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Charles Marcus
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Fabrizio Panaro
- Department of Surgery, Division of HBP Surgery & Transplantation, Saint Eloi Hospital, Montpellier University Hospital, School of Medicine, 34000, Montpellier, France
| | - Joris Erdmann
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | - Nevena Manevska
- Institute of Pathophysiology and Nuclear Medicine, Acad Isak S. Tadzer, Skopje, Macedonia
| | - Renee Moadel
- Division of Neuroradiology, Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands; Department of Radiation Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Roel J Bennink
- Cancer Center Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands
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Dasari BVM, Raptis D, Syn N, Serrablo A, Ramia JM, Laurenzi A, Sturesson C, Pawlik TM, Siriwardena AK, Lesurtel M. Development and validation of a novel risk score to predict overall survival following surgical clearance of bilobar colorectal liver metastases. BJS Open 2023; 7:zrad085. [PMID: 37738617 PMCID: PMC10516618 DOI: 10.1093/bjsopen/zrad085] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Bilobar liver metastases from colorectal cancer pose a challenge for obtaining a satisfactory oncological outcome with an adequate future liver remnant. This study aimed to assess the clinical and pathological determinants of overall survival and recurrence-free survival among patients undergoing surgical clearance of bilobar liver metastases from colorectal cancer. METHODS A retrospective international multicentre study of patients who underwent surgery for bilobar liver metastases from colorectal cancer between January 2012 and December 2018 was conducted. Overall survival and recurrence-free survival at 1, 2, 3 and 5 years after surgery were the primary outcomes evaluated. The secondary outcomes were duration of postoperative hospital stay, and 90-day major morbidity and mortality rates. A prognostic nomogram was developed using covariates selected from a Cox proportional hazards regression model, and internally validated using a 3:1 random partition into derivation and validation cohorts. RESULTS A total of 1236 patients were included from 70 centres. The majority (88 per cent) of the patients had synchronous liver metastases. Overall survival at 1, 2, 3 and 5 years was 86.4 per cent, 67.5 per cent, 52.6 per cent and 33.8 per cent, and the recurrence-free survival rates were 48.7 per cent, 26.6 per cent, 19.2 per cent and 10.5 per cent respectively. A total of 25 per cent of patients had recurrent disease within 6 months. Margin positivity and progressive disease at liver resection were poor prognostic factors, while adjuvant chemotherapy in margin-positive resections improved overall survival. The bilobar liver metastases from colorectal cancer-overall survival nomogram was developed from the derivation cohort based on pre- and postoperative factors. The nomogram's ability to forecast overall survival at 1, 2, 3 and 5 years was subsequently validated on the validation cohort and showed high accuracy (overall C-index = 0.742). CONCLUSION Despite the high recurrence rates, overall survival of patients undergoing surgical resection for bilobar liver metastases from colorectal cancer is encouraging. The novel bilobar liver metastases from colorectal cancer-overall survival nomogram helps in counselling and informed decision-making of patients planned for treatment of bilobar liver metastases from colorectal cancer.
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Affiliation(s)
- Bobby V M Dasari
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of HPB Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - Dimitri Raptis
- Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Nicholas Syn
- Department of HPB Surgery and Liver Transplantation, National University of Singapore, Singapore
| | - Alejandro Serrablo
- HBP Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain
| | - Jose Manuel Ramia
- Department of Hepatobiliary Surgery and Liver Transplantation, Hospital General Universitario de Alicante, Alicante, Spain
| | - Andrea Laurenzi
- Hepatobiliary Surgery and Organ Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Timothy M Pawlik
- Division of Surgery, Oncology, and Health Services Management and Policy, The Ohio State University Wexner Medical Center, Ohio, USA
| | - Ajith K Siriwardena
- Department of Hepatobiliary Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Mickael Lesurtel
- Department of HPB Surgery & Liver Transplantation, Beaujon Hospital—University of Paris Cité, Paris, France
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Jansson H, Cornillet M, Sun D, Filipovic I, Sturesson C, O’Rourke CJ, Andersen JB, Björkström NK, Sparrelid E. Preoperative immunological plasma markers TRAIL, CSF1 and TIE2 predict survival after resection for biliary tract cancer. Front Oncol 2023; 13:1169537. [PMID: 37404757 PMCID: PMC10315823 DOI: 10.3389/fonc.2023.1169537] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Systemic inflammatory markers have been validated as prognostic factors for patients with biliary tract cancer (BTC). The aim of this study was to evaluate specific immunologic prognostic markers and immune responses by analyzing preoperative plasma samples from a large prospectively collected biobank. Methods Expression of 92 proteins representing adaptive and innate immune responses was investigated in plasma from 102 patients undergoing resection for BTC 2009-2017 (perihilar cholangiocarcinoma n=46, intrahepatic cholangiocarcinoma n=27, gallbladder cancer n=29), by means of a high-throughput multiplexed immunoassay. Association with overall survival was analyzed by Cox regression, with internal validation and calibration. Tumor tissue bulk and single-cell gene expression of identified markers and receptors/ligands was analyzed in external cohorts. Results Three preoperative plasma markers were independently associated with survival: TRAIL, TIE2 and CSF1, with hazard ratios (95% confidence intervals) 0.30 (0.16-0.56), 2.78 (1.20-6.48) and 4.02 (1.40-11.59) respectively. The discrimination of a preoperative prognostic model with the three plasma markers was assessed with concordance-index 0.70, while the concordance-index of a postoperative model with histopathological staging was 0.66. Accounting for subgroup differences, prognostic factors were assessed for each type of BTC. TRAIL and CSF1 were prognostic factors in intrahepatic cholangiocarcinoma. In independent cohorts, TRAIL-receptor expression was higher in tumor tissue and seen in malignant cells, with TRAIL and CSF1 expressed by intra- and peritumoral immune cells. Intratumoral TRAIL-activity was decreased compared to peritumoral immune cells, while CSF1-activity was increased. The highest CSF1 activity was seen in intratumoral macrophages, while the highest TRAIL-activity was seen in peritumoral T-cells. Discussion In conclusion, three preoperative immunological plasma markers were prognostic for survival after surgery for BTC, providing good discrimination, even compared to postoperative pathology. TRAIL and CSF1, prognostic factors in intrahepatic cholangiocarcinoma, showed marked differences in expression and activity between intra- and peritumoral immune cells.
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Affiliation(s)
- Hannes Jansson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Cornillet
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Dan Sun
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Iva Filipovic
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Sturesson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Colm J. O’Rourke
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper B. Andersen
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niklas K. Björkström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Ghazanfar MA, Abdelhamid A, Aldrighetti L, Sturesson C, Takemura N, Truant S, Fiorentini G, Teh C, Alikhanov R, Ahmed I, Hammond J, Ferrero A, Silva M, Pawlik T, Jones R, Bekheit M. The dilemma of the disappearing colorectal liver metastases: defining international trends in management. HPB (Oxford) 2023; 25:446-453. [PMID: 36775699 DOI: 10.1016/j.hpb.2023.01.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE This survey sought to appraise the degree of consistency in the management of disappeared colorectal liver metastases (dCRLM) among liver surgeons in different countries. BACKGROUND Colorectal liver metastases (CRLM) account for half of the deaths secondary to colorectal cancer. Due to the high utilization of chemotherapy before surgery, some or all CRLM can disappear (dCRLM) but management of dCRLMs remains unclear. METHODS Seven simulated scenarios of dCRLM were presented to experienced liver surgeons using an online platform. Treatment decisions were submitted and analysed using the multi-rater kappa method. The effect of the experience, complexity of scenarios, and location and number of dCRLM on treatment decision were analysed. RESULTS Sixty-seven liver surgeons from 25 countries completed the survey. There was no agreement about the therapeutic strategies of dCRLM in all scenarios (kappa 0.12, IQR 0.20-0.32). In scenarios with lower difficulty scores, surgeons tended to offer surgical resection for dCRLM alongside the visible CRLM (vCRLM), however, with poor agreement (kappa 0.32, IQR 0.19-0.51). No agreement was seen for clinical scenario in which all CRLM lesions disappeared (kappa 0.20). CONCLUSION There are clear inconsistencies in the management decisions of dCRLM. Better evidence is required to define optimal management strategies.
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Affiliation(s)
- Mudassar A Ghazanfar
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK; Department of HPB Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Amir Abdelhamid
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK; Department of HPB Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nobuyuki Takemura
- Department of Surgery, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Stephanie Truant
- Department of Surgery, Centre Hospitalier Régional Universitaire de Lille: Lille, Nord-Pas-de-Calais, Lille, France
| | - Guido Fiorentini
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic Rochester, Rochester, USA
| | - Catherine Teh
- Department of Surgery, Makati Medical Center, Makati Metro Manila, Philippines; Department of Surgery, National Kidney & Transplant Institute, Quezon, Philippines; Department of Surgery, St Luke's Medical Center, Quezon, Philippines
| | - Ruslan Alikhanov
- Moscow Clinical Scientific Center, Department of Liver and Pancreatic Surgery and Transplantation, Russia
| | - Irfan Ahmed
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK; Department of HPB Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - John Hammond
- Department of HPB and Transplantation, Freeman Hospital, Newcastle Upon Tyne, Newcastle, UK
| | | | - Michael Silva
- Department of Surgery, Oxford University Hospital, Oxford, UK
| | - Timothy Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Ohio, USA
| | - Robert Jones
- Northwest Hepatobiliary Unit, Department of Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mohamed Bekheit
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK; Department of HPB Surgery, NHS Grampian, Scotland, Aberdeen, UK; HPB Integrated Center of Care, Elite Integrated Centers of Excellence, Alexandria, Egypt.
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Andersson M, Egenvall M, Danielsson J, Thorell A, Sturesson C, Soop M, Nygren-Bonnier M, Rydwik E. CANOPTIPHYS study protocol: Optimising PHYSical function before CANcer surgery: effects of pre-operative optimisation on complications and physical function after gastrointestinal cancer surgery in older people at risk-a multicentre, randomised, parallel-group study. Trials 2023; 24:41. [PMID: 36658653 PMCID: PMC9850586 DOI: 10.1186/s13063-022-07026-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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This multicentre study explores the effects of pre-operative exercise on physical fitness, post-operative complications, recovery, and health-related quality of life in older individuals with low pre-operative physical capacity scheduled to undergo surgery for colorectal cancer. We hypothesise that this group of patients benefit from pre-operative exercise in terms of improved pre-operative physical function and lower rates of post-operative complications after surgery compared to usual care. Standardised cancer pathways in Sweden dictate a timeframe of 14-28 days from suspicion of cancer to surgery for colorectal cancer. Therefore, an exercise programme aimed to enhance physical function in the limited timeframe requires a high-intensity and high-frequency approach. METHODS Participants will be included from four sites in Stockholm, Sweden. A total of 160 participants will be randomly assigned to intervention or control conditions. Simple randomisation (permuted block randomisation) is applied with a 1:1 allocation ratio. The intervention group will perform home-based exercises (inspiratory muscle training, aerobic exercises, and strength exercises) supervised by a physiotherapist (PT) for a minimum of 6 sessions in the pre-operative period, complemented with unsupervised exercise sessions in between PT visits. The control group will receive usual care with the addition of advice on health-enhancing physical activity. The physical activity behaviour in both groups will be monitored using an activity monitor. The primary outcomes are (1) change in physical performance (6-min walking distance) in the pre-operative period and (2) post-operative complications 30 days after surgery (based on Clavien-Dindo surgical score). DISCUSSION If patients achieve functional benefits by exercise in the short period before surgery, this supports the implementation of exercise training as a clinical routine. If such benefits translate into lower complication rates and better post-operative recovery or health-related quality of life is not known but would further strengthen the case for pre-operative optimisation in colorectal cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT04878185. Registered on 7 May 2021. https://clinicaltrials.gov/ct2/home.
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Affiliation(s)
- Mikael Andersson
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Monika Egenvall
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna Danielsson
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ,grid.414628.d0000 0004 0618 1631Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Christian Sturesson
- grid.24381.3c0000 0000 9241 5705Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mattias Soop
- grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ,grid.414628.d0000 0004 0618 1631Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Rydwik
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden ,Stockholm Region Council, FOU nu, Research and Development Unit for the Elderly, Järfälla, Sweden
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Braunwarth E, Ratti F, Aldrighetti L, Al-Saffar HA, D Souza MA, Sturesson C, Linke R, Schnitzbauer A, Bodingbauer M, Kaczirek K, Vagg D, Toogood G, Ferraro D, Fusai GK, Diaz-Nieto R, Malik H, Hoogwater FJH, Wagner D, Kornprat P, Fischer I, Függer R, Göbel G, Öfner D, Stättner S. Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction - A international multicenter study. HPB (Oxford) 2023; 25:54-62. [PMID: 36089466 DOI: 10.1016/j.hpb.2022.08.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/03/2022] [Accepted: 08/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions. METHODS Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases. RESULTS Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001). CONCLUSION This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients' postoperative course negatively.
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Affiliation(s)
- Eva Braunwarth
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Francesca Ratti
- Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Hasan A Al-Saffar
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Melroy A D Souza
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Richard Linke
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General-, Visceral-, Transplant- and Thoracic Surgery, Frankfurt am Main, Germany
| | - Andreas Schnitzbauer
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General-, Visceral-, Transplant- and Thoracic Surgery, Frankfurt am Main, Germany
| | - Martin Bodingbauer
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Vagg
- Department of Hepatobiliary Surgery, St James's University Hospital, Leeds, UK; Faculty of Medicine and Health, The University of Sydney, Australia
| | - Giles Toogood
- Department of Hepatobiliary Surgery, St James's University Hospital, Leeds, UK
| | - Daniele Ferraro
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK; Department of Gastroenterology, AORN Antonio Cardarelli, Naples, Italy
| | - Giuseppe K Fusai
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | | | | | - Frederik J H Hoogwater
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Doris Wagner
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Peter Kornprat
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Ines Fischer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
| | | | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria.
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Reistad N, Sturesson C. Distinguishing tumor from healthy tissue in human liver ex vivo using machine learning and multivariate analysis of diffuse reflectance spectra. J Biophotonics 2022; 15:e202200140. [PMID: 35860880 DOI: 10.1002/jbio.202200140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/06/2022] [Revised: 06/27/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
The aim of this work was to evaluate the capability of diffuse reflectance spectroscopy to distinguish malignant liver tissues from surrounding tissues and to determine whether an extended wavelength range (450-1550 nm) offers any advantages over using the conventional wavelength range. Furthermore, multivariate analysis combined with a machine learning algorithm, either linear discriminant analysis or the more advanced support vector machine, was used to discriminate between and classify freshly excised human liver specimens from 18 patients. Tumors were distinguished from surrounding liver tissues with a sensitivity of 99%, specificity of 100%, classification rate of 100% and a Matthews correlation coefficient of 100% using the extended wavelength range and a combination of principal component analysis and support vector techniques. The results indicate that this technology may be useful in clinical applications for real-time tissue diagnostics of tumor margins where rapid classification is important.
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Affiliation(s)
- Nina Reistad
- Department of Physics, Lund University, Lund, Sweden
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Perri G, Bortolato C, Marchegiani G, Holmberg M, Romandini E, Sturesson C, Bassi C, Sparrelid E, Ghorbani P, Salvia R. Pure biliary leak vs. pancreatic fistula associated: non-identical twins following pancreatoduodenectomy. HPB (Oxford) 2022; 24:1474-1481. [PMID: 35367129 DOI: 10.1016/j.hpb.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/17/2021] [Revised: 02/23/2022] [Accepted: 03/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliary leak (BL) after pancreatoduodenectomy (PD) may have diffrent severity depending on its association with postoperative pancreatic fistula (POPF). METHODS Data of 2715 patients undergoing PD between 2011 and 2020 at two European third-level referral Centers for pancreatic surgery were retrospectively reviewed. These included BL incidences, grading, outcomes, specific treatments, and association with POPF. RESULTS BL occurred in 6% of patients undergoing PD. Among 143 BL patients, 47% had an associated POPF and 53% a pure BL. Major morbidity (64% vs 36%) and mortality (19% vs 4%) were higher in POPF-associated BL group (all P< 0.01). Day of BL onset was similar between groups (POD 2 vs 3; P = 0.2), while BL closure occurred earlier in pure BL (POD 12 vs 23; P < 0.01). Conservative treatment was more frequent (55% vs 15%; P < 0.01), and the rate of percutaneous and/or trans-hepatic drain placement was lower (30% vs 16%; P = 0.04) in pure BL group. Relaparotomy was more common in POPF-associated BL group (42% VS 17%; P < 0.01) but was performed earlier in pure BL (POD 2 vs 10; P = 0.02). CONCLUSIONS Pure BL represents a more benign entity, managed conservatively in half of the cases.
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Affiliation(s)
- Giampaolo Perri
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Cecilia Bortolato
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy; Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy.
| | - Marcus Holmberg
- Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Romandini
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Christian Sturesson
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Poya Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
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Sturesson C, Engstrand J, Strömberg C. Reply to: The cohort data in the full pulmonary Metastasectomy in colorectal cancer study: Comment on Engstrand et al. Eur J Surg Oncol 2022; 48:1874. [DOI: 10.1016/j.ejso.2022.05.021] [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] [Received: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
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Engstrand J, Sterner J, Hasselgren K, Stromberg C, Sturesson C. Treatment intention and outcome in patients with simultaneously diagnosed liver and lung metastases from colorectal cancer. European Journal of Surgical Oncology 2022; 48:1799-1806. [DOI: 10.1016/j.ejso.2022.03.006] [Citation(s) in RCA: 2] [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] [Received: 10/04/2021] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 12/13/2022]
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Eriksson S, Bengtsson J, Torén W, Lätt J, Andersson R, Sturesson C. Changes in apparent diffusion coefficient and pathological response in colorectal liver metastases after preoperative chemotherapy. Acta Radiol 2022; 64:51-57. [PMID: 35084232 DOI: 10.1177/02841851221074496] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The pathological response to preoperative chemotherapy of colorectal liver metastases (CRLMs) is predictive of long-term prognosis after liver resection. Accurate preoperative assessment of chemotherapy response could enable treatment optimization. PURPOSE To investigate whether changes in lesion-apparent diffusion coefficient (ADC) measured with diffusion-weighted magnetic resonance imaging (MRI) can be used to assess pathological treatment response in patients with CRLMs undergoing preoperative chemotherapy. MATERIAL AND METHODS Patients who underwent liver resection for CRLMs after preoperative chemotherapy between January 2011 and December 2019 were retrospectively included if they had undergone MRI before and after preoperative chemotherapy on the same 1.5-T MRI scanner with diffusion-weighted imaging with b-values 50, 400, and 800 s/mm2. The pathological chemotherapy response was assessed using the tumor regression grade (TRG) by AJCC/CAP. Lesions were divided into two groups: pathological responding (TRG 0-2) and non-responding (TRG 3). The change in lesion ADC after preoperative chemotherapy was compared between responding and non-responding lesions. RESULTS A total of 27 patients with 49 CRLMs were included, and 24/49 lesions showed a pathological chemotherapy response. After chemotherapy, ADC increased in both pathological responding (pretreatment ADC: 1.26 [95% confidence interval (CI)=1.06-1.37] vs. post-treatment ADC: 1.33 [95% CI=1.13-1.56] × 10-3 mm2/s; P = 0.026) and non-responding lesions (1.12 [95% CI=0.980-1.21] vs. 1.20 [95% CI=1.09-1.43] × 10-3 mm2/s; P = 0.018). There was no difference in median relative difference in ADC after chemotherapy between pathological responding and non-responding lesions (15.8 [95% CI=1.42-26.3] vs. 7.17 [95% CI=-4.31 to 31.2]%; P = 0.795). CONCLUSION Changes in CRLM ADCs did not differ between pathological responding and non-responding lesions.
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Affiliation(s)
- Sam Eriksson
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden
| | - Johan Bengtsson
- Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - William Torén
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Jimmy Lätt
- Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden
| | - Roland Andersson
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Christian Sturesson
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Nassar A, Cimpean S, Abdelhamid A, Jones RP, Wahba R, Fiorentini G, Aldrighetti L, Teh C, Alikhanov R, Hammond J, Silva M, Abdelmabod A, Truant S, Ferrero A, Sturesson C, Ahmed I, Ghazanfar M, Takemura N, Pawlik TM, Bekheit M. OUP accepted manuscript. BJS Open 2022; 6:6590408. [PMID: 35598157 PMCID: PMC9124362 DOI: 10.1093/bjsopen/zrac051] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/05/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ahmed Nassar
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Sorin Cimpean
- Department of Surgery, CHU - St Pierre, Brussels, Belgium
| | - Amir Abdelhamid
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Robert P. Jones
- Northwest Hepatobiliary Unit, Department of Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Roger Wahba
- Departement of General, Visceral, Cancer and Transplantation Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Guido Fiorentini
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic Rochester, Rochester, USA
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | - Catherine Teh
- Department of Surgery, Makati Medical Center, Makati Metro Manila, Philippines
- Department of Surgery, National Kidney & Transplant Institute, Quezon, Philippines
- Department of Surgery, St Luke’s Medical Center, Quezon, Philippines
| | - Ruslan Alikhanov
- Moscow Clinical Scientific Center, Department of liver and pancreatic surgery and Transplantation, Russia
| | - John Hammond
- Department of HPB and Transplantation, Freeman Hospital, Newcastle upon Tyne, Newcastle, UK
| | - Michael Silva
- Department of Surgery, Oxford University Hospital, Oxford, UK
| | - Areeg Abdelmabod
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Stephanie Truant
- Department of Surgery, Centre Hospitalier Régional Universitaire de Lille: Lille, Nord-Pas-de-Calais, Lille, France
| | | | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Irfan Ahmed
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Mudassar Ghazanfar
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Nobuyuki Takemura
- Department of Surgery, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Ohio, USA
| | - Mohamed Bekheit
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
- Surgical Unit, HPB Integrated Center of Care, Elite Integrated Centers of Excellence, Alexandria, Egypt
- Correspondence to: Mohamed Bekheit, Department of Surgery, Aberdeen Royal Infirmary, Department of Surgery, Foresthill Health Campus, Aberdeen AB252ZN, UK (e-mail: )
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Engstrand J, Abreu de Carvalho LF, Aghayan D, Balakrishnan A, Belli A, Björnsson B, Dasari BVM, Detry O, Di Martino M, Edwin B, Erdmann J, Fristedt R, Fusai G, Gimenez-Maurel T, Hemmingsson O, Hidalgo Salinas C, Isaksson B, Ivanecz A, Izzo F, Knoefel WT, Kron P, Lehwald-Tywuschik N, Lesurtel M, Lodge JPA, Machairas N, Marino MV, Martin V, Paterson A, Rystedt J, Sandström P, Serrablo A, Siriwardena AK, Taflin H, van Gulik TM, Yaqub S, Özden I, Ramia JM, Sturesson C. Liver resection and ablation for squamous cell carcinoma liver metastases. BJS Open 2021; 5:6356812. [PMID: 34426830 PMCID: PMC8382975 DOI: 10.1093/bjsopen/zrab060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/17/2021] [Indexed: 12/30/2022] Open
Abstract
Background Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS). Method Members of the European–African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS. Results Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30). Conclusion Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome.
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Affiliation(s)
- J Engstrand
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - L F Abreu de Carvalho
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - D Aghayan
- The Intervention Centre, Oslo University Hospital, Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - A Balakrishnan
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Belli
- Department of Abdominal Oncology, HPB Surgical Oncology Unit, National Cancer Institute, Fondazione G. Pascale-IRCCS, Naples, Italy
| | - B Björnsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - B V M Dasari
- Department of Hepatobiliary and Pancreatic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - O Detry
- Department of Abdominal Surgery and Transplantation, CHU Liège, Liège, Belgium
| | - M Di Martino
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - B Edwin
- The Intervention Centre, Oslo University Hospital, Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - J Erdmann
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - R Fristedt
- Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - G Fusai
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London, UK
| | - T Gimenez-Maurel
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - O Hemmingsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - C Hidalgo Salinas
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London, UK
| | - B Isaksson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - A Ivanecz
- Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | - F Izzo
- Department of Abdominal Oncology, HPB Surgical Oncology Unit, National Cancer Institute, Fondazione G. Pascale-IRCCS, Naples, Italy
| | - W T Knoefel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - P Kron
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Lehwald-Tywuschik
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - M Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - J P A Lodge
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Machairas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo (PA), Abano, Italy.,General Surgery Department, Policlinico Abano Terme, Abano, Italy
| | - V Martin
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - A Paterson
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Rystedt
- Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - P Sandström
- Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - A K Siriwardena
- Hepatobiliary Surgery Unit, Manchester Royal Infirmary, Manchester, UK
| | - H Taflin
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - T M van Gulik
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - S Yaqub
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - I Özden
- Department of General Surgery, Istanbul University School of Medicine, Istanbul, Turkey
| | - J M Ramia
- Hospital General Universitario de Alicante. ISABIAL Alicante, Spain
| | - C Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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15
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Valdimarsson VT, Syk I, Lindell G, Sandström P, Isaksson B, Rizell M, Norén A, Ardnor B, Sturesson C. Outcomes of Simultaneous Resections and Classical Strategy for Synchronous Colorectal Liver Metastases in Sweden: A Nationwide Study with Special Reference to Major Liver Resections. World J Surg 2021; 44:2409-2417. [PMID: 32185455 PMCID: PMC7266839 DOI: 10.1007/s00268-020-05475-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background About 20% of patients with colorectal cancer have liver metastases at the time of diagnosis, and surgical resection offers a chance for cure. The aim of the present study was to compare outcomes for patients that underwent simultaneous resection to those that underwent a staged procedure with the bowel-first (classical) strategy by using information from two national registries in Sweden. Methods In this prospectively registered cohort study, we analyzed clinical, pathological, and survival outcomes for patients operated in the period 2008–2015 and compared the two strategies. Results In total, 537 patients constituted the study cohort, where 160 were treated with the simultaneous strategy and 377 with the classical strategy. Patients managed with the simultaneous strategy had less often rectal primary tumors (22% vs. 31%, p = 0.046) and underwent to a lesser extent a major liver resection (16% vs. 41%, p < 0.001), but had a shorter total length of stay (11 vs. 15 days, p < 0.001) and more complications (52% vs. 36%, p < 0.001). No significant 5-year overall survival (p = 0.110) difference was detected. Twenty-five patients had a major liver resection in the simultaneous strategy group and 155 in the classical strategy group without difference in 5-year overall survival (p = 0.198). Conclusion Simultaneous resection of the colorectal primary cancer and liver metastases can possibly have more complications, with no difference in overall survival compared to the classical strategy.
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Affiliation(s)
- Valentinus T Valdimarsson
- Department of Clinical Sciences Lund, Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Ingvar Syk
- Department of Clinical Sciences Malmö, Surgery, Skane University Hospital, Lund University, Malmö, Sweden
| | - Gert Lindell
- Department of Clinical Sciences Lund, Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Per Sandström
- Department of Surgery, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Rizell
- Department of Transplantation and Liver Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Norén
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bjarne Ardnor
- Department of Surgery, Umeå University Hospital, Umeå, Sweden
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden.
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16
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Barimani D, Kauppila JH, Sturesson C, Sparrelid E. Imaging in disappearing colorectal liver metastases and their accuracy: a systematic review. World J Surg Oncol 2020; 18:264. [PMID: 33032620 PMCID: PMC7545848 DOI: 10.1186/s12957-020-02037-w] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/25/2020] [Indexed: 12/14/2022] Open
Abstract
Background Approximately 30% of patients with colorectal cancer develop colorectal liver metastases (CRLM). CRLM that become undetectable by imaging after chemotherapy are called disappearing liver metastases (DLM). But a DLM is not necessarily equal to cure. An increasing incidence of patients with DLM provides surgeons with a difficult dilemma: to resect or to not resect the original sites of DLM? The aim of this review was to investigate to what extent a DLM equates a complete response (CR) and to compare outcomes. Methods This review was conducted in accordance with the PRISMA guidelines and registered in Prospero (registration number CRD42017070441). Literature search was made in the PubMed and Embase databases. During the process of writing, PubMed was repeatedly searched and reference lists of included studies were screened for additional studies of interest for this review. Results were independently screened by two authors with the Covidence platform. Studies eligible for inclusion were those reporting outcomes of DLM in adult patients undergoing surgery following chemotherapy. Results Fifteen studies were included with a total of 2955 patients with CRLM. They had 4742 CRLM altogether. Post-chemotherapy, patients presented with 1561 DLM. Patients with one or more DLM ranged from 7 to 48% (median 19%). Median DLM per patient was 3.4 (range 0.4–5.6). Patients were predominantly evaluated by contrast-enhanced computed tomography (CE-CT) before and after chemotherapy, with some exceptions and with addition of magnetic resonance imaging (MRI) in some studies. Intraoperative ultrasound (IOUS) was universally performed in all but two studies. If a DLM remained undetectable by IOUS, this DLM represented a CR in 24–96% (median 77.5%). Further, if a DLM on preoperative CE-CT remained undetectable by additional workup with MRI and CE-IOUS, this DLM was equal to a CR in 75–94% (median 89%). Patients with resected DLM had a longer disease-free survival compared to patients with DLM left in situ but statistically significant differences in overall survival could not be found. Conclusion Combination of CE-CT, MRI, and IOUS showed promising results in accurately identifying DLM with CR. This suggests that leaving DLM in situ could be an alternative to surgical resection when a DLM remains undetectable by MRI and IOUS.
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Affiliation(s)
- Darius Barimani
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
| | - Joonas H Kauppila
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.,Surgery Research Unit, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
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17
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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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18
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Sturesson C, Hemmingsson O, Månsson C, Sandström P, Strömberg C, Taflin H, Rystedt J. Quality-of-life after bile duct injury repaired by hepaticojejunostomy: a national cohort study. Scand J Gastroenterol 2020; 55:1087-1092. [PMID: 32735151 DOI: 10.1080/00365521.2020.1800076] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Reports on quality-of-life (QoL) after bile duct injury (BDI) show conflicting results. The aim of this cohort study was to evaluate QoL stratified according to type of treatment. METHODS QoL assessment using the SF-36 (36-item short form health survey) questionnaire. Patients with post-cholecystectomy BDI needing hepaticojejunostomy (HJ) were compared to all other treatments (BDI repair) and to patients without BDI at cholecystectomy (controls). RESULTS Patients needing a HJ after BDI reported reduced long-term QoL irrespective of time for diagnosis and repair in both the physical (PCS; p < .001) and mental (MCS; p < .001) domain compared to both controls and patients with less severe BDI. QoL was comparable for BDI repair (n = 86) and controls (n = 192) in both PCS (p = .171) and MCS (p = .654). As a group, patients with BDI (n = 155) reported worse QoL than controls, in both the PCS (p < .001) and MCS (p = .012). Patients with a BDI detected intraoperatively (n = 124) reported better QoL than patients with a postoperative diagnosis. Patients with an immediate intraoperative repair (n = 99), including HJ, reported a better long-term QoL compared to patients subjected to a later procedure (n = 54). CONCLUSIONS Patients with postoperative diagnosis and patients with BDIs needing biliary reconstruction with HJ both reported reduced long-term QoL.
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Affiliation(s)
- Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Oskar Hemmingsson
- Department of Surgical And Perioperative Sciences, Umeå University, Umeå, Sweden
| | | | - Per Sandström
- Department of Surgery, Clinical and Experimental Medicine, University Hospital, Linköping, Sweden
| | - Cecilia Strömberg
- Division of Surgery, Department of Clinical Science, Intervention and Technology, (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Taflin
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Transplant Centre, Gothenburg, Sweden
| | - Jenny Rystedt
- Department of Surgery, Skane University Hospital, Lund University, Lund, Sweden
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19
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Jansson H, Cornillet M, Björkström NK, Sturesson C, Sparrelid E. Prognostic value of preoperative inflammatory markers in resectable biliary tract cancer - Validation and comparison of the Glasgow Prognostic Score and Modified Glasgow Prognostic Score in a Western cohort. Eur J Surg Oncol 2019; 46:804-810. [PMID: 31848078 DOI: 10.1016/j.ejso.2019.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/22/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Established preoperative prognostic factors for risk stratification of patients with biliary tract cancer (BTC) are lacking. A prognostic value of the inflammation-based Glasgow Prognostic Score (GPS) and Modified Glasgow Prognostic Score (mGPS) in BTC has been indicated in several Eastern cohorts. We sought to validate and compare the prognostic value of the GPS and the mGPS for overall survival (OS), in a large Western cohort of patients with BTC. MATERIAL AND METHODS We performed a retrospective single-center study for the period 2009 until 2017. 216 consecutive patients that underwent surgical exploration with a diagnosis of perihilar cholangiocarcinoma (PHCC), intrahepatic cholangiocarcinoma (IHCC), or gallbladder cancer (GBC) were assessed. GPS and mGPS were calculated where both CRP and albumin were measured pre-operatively (n = 168/216). Survival was analyzed by Kaplan-Meier estimate and uni-/multivariate Cox regression. RESULTS GPS and mGPS were negatively associated with survival (p < 0.001/p < 0.001), and the association was significant in all three subgroups. GPS, but not the mGPS, identified an intermediate risk group: with GPS = 1 having better OS than GPS = 2 (p = 0.003), but worse OS than GPS = 0 (p = 0.008). In multivariate analyses of resected patients, GPS (p = 0.001) and mGPS (p = 0.03) remained significant predictors of survival, independent of postoperatively available risk factors. CONCLUSIONS Preoperative GPS and mGPS are independent prognostic factors in BTC. The association to OS was shown in all patients undergoing exploration, in resected patients only, and in both cholangiocarcinoma and gallbladder cancer. Furthermore, GPS - which weights hypoalbuminemia higher - could identify an intermediate risk group.
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Affiliation(s)
- Hannes Jansson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Martin Cornillet
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas K Björkström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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20
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Valdimarsson VT, Hellberg K, Brismar TB, Sparrelid E, Sturesson C. Repeat procedures for recurrent colorectal liver metastases: analysis of long-term liver regeneration and outcome. Cancer Manag Res 2019; 11:2617-2622. [PMID: 31118767 PMCID: PMC6497974 DOI: 10.2147/cmar.s191653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/21/2019] [Indexed: 12/31/2022] Open
Abstract
Background and aim: Repeat hepatectomy is increasingly performed for the management of recurrent colorectal liver metastases (CRLM). The aim of this study was to evaluate long-term functional liver volume (FLV) after a second hepatic procedure and to measure survival outcome. Methods: In this retrospective cohort study, patients treated for recurrent CRLM in the years 2005-2015 at two liver centers were included. Total FLV was calculated before the first procedure and before and after the second procedure. Overall survival was calculated. Results: Eighty-two patients were identified. The median follow-up was 53 (40-71) months from the first procedure. The median interval between first and second procedure was 13 (8-22) months. The initial FLV was 1584 (1313-1927) mL. The FLV was 1438 (1204-1896) mL after the first procedure and 1470 (1172-1699) mL after the second procedure (P<0.001). After the second procedure, a total of ten patients (12%) had a residual liver volume of less than 75% of the initial liver volume. The 5-year overall survival was 37 (26-54)% after the second procedure. Conclusion: Small changes in FLV were found after two hepatic procedures but with considerable inter-individual variation. Patients selected for a repeated hepatic procedure for recurrent CRLM had an acceptable survival.
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Affiliation(s)
- Valentinus T Valdimarsson
- Department of Clinical Sciences Lund, Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Katarina Hellberg
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Torkel B Brismar
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Sturesson
- Department of Clinical Sciences Lund, Surgery, Lund University, Skane University Hospital, Lund, Sweden
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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21
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Reistad N, Nilsson JH, Bergenfeldt M, Rissler P, Sturesson C. Intraoperative liver steatosis characterization using diffuse reflectance spectroscopy. HPB (Oxford) 2019; 21:175-180. [PMID: 30049643 DOI: 10.1016/j.hpb.2018.06.1809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/01/2018] [Revised: 06/03/2018] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver steatosis is associated with poor outcome after liver transplantation and liver resection. There is a need for an accurate and reliable intraoperative tool to identify and quantify steatosis. This study aimed to investigate whether surface diffuse reflectance spectroscopy (DRS) measurements could detect liver steatosis on humans during liver surgery. METHODS The DRS instrumentation setup consists of a computer, a high-power tungsten halogen light source and two spectrometers, connected through a trifurcated optical fiber to a hand-held probe. Patients scheduled for open resection for liver tumors were considered for inclusion. Multiple DRS measurements were performed on the liver surface after mobilization. RESULTS In total, 1210 DRS spectra originated from 38 patients, were analyzed. When applying the data to an analytical model the volumetric absorption ratio factor of fat and water specified an explicit distinction between mild to moderate, and moderate to severe steatosis (p < 0.001). There were significant differences between none-to-mild and moderate-to-severe steatosis grade for the following parameters: reduced scattering coefficient (p < 0.001), Mie to total scattering fraction (p < 0.001), Mie slope (p = 0.003), lipid/(lipid + water) (p < 0.001), blood volume (p = 0.044) and bile volume (p < 0.001). CONCLUSION This study shows that it is possible to evaluate steatosis grades with hepatic surface diffuse reflectance spectroscopy measurements.
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Affiliation(s)
- Nina Reistad
- Department of Physics, Lund University, Lund, Sweden
| | - Jan H Nilsson
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Magnus Bergenfeldt
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Pehr Rissler
- Department of Pathology, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Christian Sturesson
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden.
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22
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Klompmaker S, Peters NA, van Hilst J, Bassi C, Boggi U, Busch OR, Niesen W, Van Gulik TM, Javed AA, Kleeff J, Kawai M, Lesurtel M, Lombardo C, Moser AJ, Okada KI, Popescu I, Prasad R, Salvia R, Sauvanet A, Sturesson C, Weiss MJ, Zeh HJ, Zureikat AH, Yamaue H, Wolfgang CL, Hogg ME, Besselink MG. Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis. Ann Surg Oncol 2019; 26:772-781. [PMID: 30610560 PMCID: PMC6373251 DOI: 10.1245/s10434-018-07101-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Indexed: 12/15/2022]
Abstract
Background Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. Methods This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000–2016) and three very-high-volume international centers in the United States and Japan (model validation 2004–2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. Results For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2–11%) at 5 high-volume (≥ 1 DP-CAR/year) and 18% (95 CI, 9–30%) at 18 low-volume DP-CAR centers (P = 0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P = 0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19 months (95 CI, 15–25 months). Conclusions When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor. Electronic supplementary material The online version of this article (10.1245/s10434-018-07101-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sjors Klompmaker
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niek A Peters
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Surgery, University of Utrecht Medical Center, Utrecht, The Netherlands
| | - Jony van Hilst
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio Bassi
- Department of Surgery, Pancreas Institute University of Verona, Verona, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Olivier R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem Niesen
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Thomas M Van Gulik
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ammar A Javed
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jorg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mickael Lesurtel
- Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Carlo Lombardo
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - A James Moser
- The Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ken-Ichi Okada
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Irinel Popescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Raj Prasad
- Department of HPB and Transplant Services, National Health Service, Leeds, UK
| | - Roberto Salvia
- Department of Surgery, Pancreas Institute University of Verona, Verona, Italy
| | - Alain Sauvanet
- Department of HPB Surgery, Hôpital Beaujon, APHP, University Paris VII, Clichy, France
| | - Christian Sturesson
- Division of Surgery, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Matthew J Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amer H Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | | | - Melissa E Hogg
- Department of Surgery, Northshore University HealthSystem, Chicago, IL, USA
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Valdimarsson VT, Syk I, Lindell G, Norén A, Isaksson B, Sandström P, Rizell M, Ardnor B, Sturesson C. Outcomes of liver-first strategy and classical strategy for synchronous colorectal liver metastases in Sweden. HPB (Oxford) 2018; 20:441-447. [PMID: 29242035 DOI: 10.1016/j.hpb.2017.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 09/18/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with synchronous colorectal liver metastases (sCRLM) are increasingly operated with liver resection before resection of the primary cancer. The aim of this study was to compare outcomes in patients following the liver-first strategy and the classical strategy (resection of the bowel first) using prospectively registered data from two nationwide registries. METHODS Clinical, pathological and survival outcomes were compared between the liver-first strategy and the classical strategy (2008-2015). Overall survival was calculated. RESULTS A total of 623 patients were identified, of which 246 were treated with the liver-first strategy and 377 with the classical strategy. The median follow-up was 40 months. Patients chosen for the classical strategy more often had T4 primary tumours (23% vs 14%, P = 0.012) and node-positive primaries (70 vs 61%, P = 0.015). The liver-first patients had a higher liver tumour burden score (4.1 (2.5-6.3) vs 3.6 (2.2-5.1), P = 0.003). No difference was seen in five-year overall survival between the groups (54% vs 49%, P = 0.344). A majority (59%) of patients with rectal cancer were treated with the liver-first strategy. CONCLUSION The liver-first strategy is currently the dominant strategy for sCRLM in patients with rectal cancer in Sweden. No difference in overall survival was noted between strategies.
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Affiliation(s)
- Valentinus T Valdimarsson
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden
| | - Ingvar Syk
- Lund University, Skane University Hospital, Department of Clinical Sciences Malmö, Surgery, Malmö, Sweden
| | - Gert Lindell
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden
| | - Agneta Norén
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
| | - Per Sandström
- Department of Surgery, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Magnus Rizell
- Department of Transplantation and Liver Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bjarne Ardnor
- Department of Surgery, Umeå University Hospital, Umeå, Sweden
| | - Christian Sturesson
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden; Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden.
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Klompmaker S, van Hilst J, Gerritsen SL, Adham M, Teresa Albiol Quer M, Bassi C, Berrevoet F, Boggi U, Busch OR, Cesaretti M, Dalla Valle R, Darnis B, De Pastena M, Del Chiaro M, Grützmann R, Diener MK, Dumitrascu T, Friess H, Ivanecz A, Karayiannakis A, Fusai GK, Labori KJ, Lombardo C, López-Ben S, Mabrut JY, Niesen W, Pardo F, Perinel J, Popescu I, Roeyen G, Sauvanet A, Prasad R, Sturesson C, Lesurtel M, Kleeff J, Salvia R, Besselink MG. Correction to: Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study. Ann Surg Oncol 2018; 25:988. [PMID: 29560574 DOI: 10.1245/s10434-018-6442-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the original article, the institutional author the E-AHPBA DP-CAR study group was misspelled. It is correct as reflected here. The original article has also been corrected.
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Affiliation(s)
- Sjors Klompmaker
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | - Jony van Hilst
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | - Sarah L Gerritsen
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | - Mustapha Adham
- Department of Digestive Surgery, E. Herriot Hospital, HCL, UCBL1, Lyon, France
| | - M Teresa Albiol Quer
- Department of Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Claudio Bassi
- Department of Surgery, University of Verona, Verona, Italy
| | - Frederik Berrevoet
- Department of General and HPB Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Olivier R Busch
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - Benjamin Darnis
- Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | | | - Marco Del Chiaro
- Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Traian Dumitrascu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | | | - Giuseppe K Fusai
- HPB Surgery and Liver Transplantation Unit, Royal Free Hospital, London, UK
| | - Knut J Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Carlo Lombardo
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Santiago López-Ben
- Department of Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Jean-Yves Mabrut
- Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Willem Niesen
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Fernando Pardo
- Department of HPB and Transplant Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Julie Perinel
- Department of Digestive Surgery, E. Herriot Hospital, HCL, UCBL1, Lyon, France
| | - Irinel Popescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Geert Roeyen
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Alain Sauvanet
- Department of HPB Surgery, Hôpital Beaujon, Clichy Cedex, France
| | - Raj Prasad
- Department of HPB and Transplant Services, National Health Service, Leeds, UK
| | | | - Mickael Lesurtel
- Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Jorg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Roberto Salvia
- Department of Surgery, University of Verona, Verona, Italy
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.
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Klompmaker S, van Hilst J, Gerritsen SL, Adham M, Teresa Albiol Quer M, Bassi C, Berrevoet F, Boggi U, Busch OR, Cesaretti M, Dalla Valle R, Darnis B, De Pastena M, Del Chiaro M, Grützmann R, Diener MK, Dumitrascu T, Friess H, Ivanecz A, Karayiannakis A, Fusai GK, Labori KJ, Lombardo C, López-Ben S, Mabrut JY, Niesen W, Pardo F, Perinel J, Popescu I, Roeyen G, Sauvanet A, Prasad R, Sturesson C, Lesurtel M, Kleeff J, Salvia R, Besselink MG. Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study. Ann Surg Oncol 2018. [PMID: 29532342 PMCID: PMC5891548 DOI: 10.1245/s10434-018-6391-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Western multicenter studies on distal pancreatectomy with celiac axis resection (DP-CAR), also known as the Appleby procedure, for locally advanced pancreatic cancer are lacking. We aimed to study overall survival, morbidity, mortality and the impact of preoperative hepatic artery embolization (PHAE). METHODS Retrospective cohort study within the European-African Hepato-Pancreato-Biliary-Association, on DP-CAR between 1-1-2000 and 6-1-2016. Primary endpoint was overall survival. Secondary endpoints were radicality (R0-resection), 90-day mortality, major morbidity, and pancreatic fistulae (grade B/C). RESULTS We included 68 patients from 20 hospitals in 12 countries. Postoperatively, 53% of patients had R0-resection, 25% major morbidity, 21% an ISGPS grade B/C pancreatic fistula, and 16% mortality. In total, 82% received (neo-)adjuvant chemotherapy and median overall survival in 62 patients with pancreatic ductal adenocarcinoma patients was 18 months (CI 10-37). We observed no impact of PHAE on ischemic complications. CONCLUSIONS DP-CAR combined with chemotherapy for locally advanced pancreatic cancer is associated with acceptable overall survival. The 90-day mortality is too high and should be reduced. Future studies should investigate to what extent increasing surgical volume or better patient selection can improve outcomes.
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Affiliation(s)
- Sjors Klompmaker
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | - Jony van Hilst
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | - Sarah L Gerritsen
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | - Mustapha Adham
- Department of Digestive Surgery, E. Herriot Hospital, HCL, UCBL1, Lyon, France
| | - M Teresa Albiol Quer
- Department of Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Claudio Bassi
- Department of Surgery, University of Verona, Verona, Italy
| | - Frederik Berrevoet
- Department of General and HPB Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Olivier R Busch
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - Benjamin Darnis
- Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | | | - Marco Del Chiaro
- Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Traian Dumitrascu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | | | - Giuseppe K Fusai
- HPB Surgery and Liver Transplantation Unit, Royal Free Hospital, London, UK
| | - Knut J Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Carlo Lombardo
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Santiago López-Ben
- Department of Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Jean-Yves Mabrut
- Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Willem Niesen
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Fernando Pardo
- Department of HPB and Transplant Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Julie Perinel
- Department of Digestive Surgery, E. Herriot Hospital, HCL, UCBL1, Lyon, France
| | - Irinel Popescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Geert Roeyen
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Alain Sauvanet
- Department of HPB Surgery, Hôpital Beaujon, Clichy Cedex, France
| | - Raj Prasad
- Department of HPB and Transplant Services, National Health Service, Leeds, UK
| | | | - Mickael Lesurtel
- Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Jorg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Roberto Salvia
- Department of Surgery, University of Verona, Verona, Italy
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.
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Eriksson S, Borsiin H, Öberg CF, Brange H, Mijovic Z, Sturesson C. Perioperative liver and spleen elastography in patients without chronic liver disease. World J Gastrointest Surg 2018; 10:21-27. [PMID: 29492187 PMCID: PMC5827034 DOI: 10.4240/wjgs.v10.i2.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/14/2018] [Accepted: 02/06/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate changes in hepatic and splenic stiffness in patients without chronic liver disease during liver resection for hepatic tumors.
METHODS Patients scheduled for liver resection for hepatic tumors were considered for enrollment. Tissue stiffness measurements on liver and spleen were conducted before and two days after liver resection using point shear-wave elastography. Histological analysis of the resected liver specimen was conducted in all patients and patients with marked liver fibrosis were excluded from further study analysis. Patients were divided into groups depending on size of resection and whether they had received preoperative chemotherapy or not. The relation between tissue stiffness and postoperative biochemistry was investigated.
RESULTS Results are presented as median (interquartile range). 35 patients were included. The liver stiffness increased in patients undergoing a major resection from 1.41 (1.24-1.63) m/s to 2.20 (1.72-2.44) m/s (P = 0.001). No change in liver stiffness in patients undergoing a minor resection was found [1.31 (1.15-1.52) m/s vs 1.37 (1.12-1.77) m/s, P = 0.438]. A major resection resulted in a 16% (7%-33%) increase in spleen stiffness, more (P = 0.047) than after a minor resection [2 (-1-13) %]. Patients who underwent preoperative chemotherapy (n = 20) did not differ from others in preoperative right liver lobe [1.31 (1.16-1.50) vs 1.38 (1.12-1.56) m/s, P = 0.569] or spleen [2.79 (2.33-3.11) vs 2.71 (2.37-2.86) m/s, P = 0.515] stiffness. Remnant liver stiffness on the second postoperative day did not show strong correlations with maximum postoperative increase in bilirubin (R2 = 0.154, Pearson’s r = 0.392, P = 0.032) and international normalized ratio (R2 = 0.285, Pearson’s r = 0.534, P = 0.003).
CONCLUSION Liver and spleen stiffness increase after a major liver resection for hepatic tumors in patients without chronic liver disease.
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27
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Strandberg Holka P, Eriksson S, Eberhard J, Bergenfeldt M, Lindell G, Sturesson C. Significance of poor performance status after resection of colorectal liver metastases. World J Surg Oncol 2018; 16:3. [PMID: 29304822 PMCID: PMC5755260 DOI: 10.1186/s12957-017-1306-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 12/26/2017] [Indexed: 12/29/2022] Open
Abstract
Background Performance status (PS) is known as one of the strongest prognostic factors for survival in metastatic colorectal cancer patients. The aim of the present study was to analyze factors associated with poor PS assessed after resection for colorectal liver metastases and the impact on survival. Methods All patients undergoing curative resection for colorectal liver metastases between 2010 and 2015 in a single center were reviewed retrospectively. Results A total of 284 patients were included, out of whom 74 patients (26%) presented with a postoperative PS WHO > 2 precluding administration of adjuvant chemotherapy. These patients had a shorter recurrence-free survival (P = 0.002) and shorter overall survival (P < 0.001). Multivariable analysis showed that patients with PS > 2 after surgery had higher preoperative ASA score, had a higher frequency of major complications after surgery, and had more frequently synchronous liver and lung metastases. PS was found to be the strongest independent factor predicting survival (hazard ratio 0.45). When patients with postoperative PS > 2 developed recurrent disease (54 of 74), 43 (80%) received tumor specific treatment. Conclusions Patients with postoperative PS > 2 who did not receive adjuvant chemotherapy had decreased recurrence-free and overall survival after liver resection for colorectal liver metastases. After recurrence, a large majority of these patients had had improvement in PS allowing for administration of tumor specific treatment.
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Affiliation(s)
- Peter Strandberg Holka
- Department of Clinical Sciences Lund, Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Sam Eriksson
- Department of Clinical Sciences Lund, Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Jakob Eberhard
- Department of Clinical Sciences Lund, Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - Magnus Bergenfeldt
- Department of Clinical Sciences Lund, Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Gert Lindell
- Department of Clinical Sciences Lund, Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Christian Sturesson
- Department of Clinical Sciences Lund, Surgery, Skane University Hospital, Lund University, Lund, Sweden. .,Department of Surgery, Skåne University Hospital, S-221 85, Lund, Sweden.
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Amptoulach S, Gross G, Sturesson C, Rissler P, Kalaitzakis E. Preoperative Aspartate Aminotransferase-to-Platelet Ratio Index Predicts Perioperative Liver-Related Complications Following Liver Resection for Colorectal Cancer Metastases. Scand J Surg 2017; 106:311-317. [PMID: 28737112 DOI: 10.1177/1457496916683094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/16/2022]
Abstract
BACKGROUND AND AIMS There are limited data on the potential role of preoperative non-invasive markers, specifically the aspartate-to-alanine aminotransferase ratio and the aspartate aminotransferase-to-platelet ratio index, in predicting perioperative liver-related complications after hepatectomy for colorectal cancer metastases. METHODS Patients undergoing liver resection for colorectal cancer metastases in a European institution during 2003-2010 were retrospectively enrolled. Relevant data, such as neoadjuvant chemotherapy, preoperative liver function tests, and perioperative complications, were collected from medical records. The nontumorous liver parenchyma in the surgical specimens of 31 patients was re-evaluated. RESULTS Overall, 215 patients were included. In total, 40% underwent neoadjuvant chemotherapy and 47% major resection, while 47% had perioperative complications (6% liver-related). In multivariate regression analysis, the aspartate aminotransferase-to-platelet ratio index was independently associated with liver-related complications (odds ratio: 1.149, p = 0.003) and perioperative liver failure (odds ratio: 1.155, p = 0.012). The latter was also true in the subcohort of patients with neoadjuvant chemotherapy (odds ratio: 1.157, p = 0.004) but not in those without such therapy (p = 0.062). The aspartate-to-alanine aminotransferase ratio was not related to liver-related complications (p = 0.929). The area under the receiver operating characteristics curve for the aspartate aminotransferase-to-platelet ratio index as a predictor of liver-related complications was 0.857 (p = 0.008) in patients with neoadjuvant chemotherapy. Increasing aspartate aminotransferase-to-platelet ratio index was observed with an increase in degrees of sinusoidal obstruction syndrome (p = 0.01) but not for fibrosis (p = 0.175) or steatosis (p = 0.173) in the nontumorous liver in surgical specimens. CONCLUSION The preoperative aspartate aminotransferase-to-platelet ratio index, but not the aspartate-to-alanine aminotransferase ratio, predicts perioperative liver-related complications following hepatectomy due to colorectal cancer metastases, in particular after neoadjuvant chemotherapy. The aspartate aminotransferase-to-platelet ratio index is related to sinusoidal obstruction syndrome in the nontumorous liver.
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Affiliation(s)
- S Amptoulach
- 1 Department of Oncology, Skåne University Hospital, Lund University, Lund, Sweden
| | - G Gross
- 2 Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - C Sturesson
- 2 Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,3 Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - P Rissler
- 4 Department of Pathology, Skåne University Hospital, Lund University, Lund, Sweden
| | - E Kalaitzakis
- 2 Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,5 Digestive Disease Center, Copenhagen University Hospital/Herlev, Copenhagen, Denmark
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29
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Eriksson S, Nilsson JH, Strandberg Holka P, Eberhard J, Keussen I, Sturesson C. The impact of neoadjuvant chemotherapy on skeletal muscle depletion and preoperative sarcopenia in patients with resectable colorectal liver metastases. HPB (Oxford) 2017; 19:331-337. [PMID: 28089364 DOI: 10.1016/j.hpb.2016.11.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 07/30/2016] [Revised: 11/20/2016] [Accepted: 11/30/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative skeletal muscle depletion or sarcopenia has been suggested to predict worse outcome after resection of colorectal liver metastases. The aim of the present study was to investigate the impact of neoadjuvant chemotherapy on preoperative skeletal muscle mass prior to liver resection. METHODS Patients operated with liver resection for colorectal liver metastases between 2010 and 2014 were retrospectively reviewed. Muscle mass was evaluated by measuring muscle area on a cross-sectional computed tomography image at the level of the third lumbar vertebra, and normalized for patient height, presenting a skeletal muscle index. RESULTS Preoperative skeletal muscle mass was analysed in 225 patients, of whom 97 underwent neoadjuvant chemotherapy. In total 147 patients (65%) were categorized as sarcopenic preoperatively. Patients receiving neoadjuvant chemotherapy decreased in skeletal muscle mass (decrease by 5.5 (-1.1 to 11) % in skeletal muscle index, p < 0.001). Patients with muscle loss >5% during neoadjuvant chemotherapy were less likely to undergo adjuvant chemotherapy than others (68% vs 85%, p = 0.048). A >5% muscle loss did not result in worse overall (p = 0.131) or recurrence-free survival (p = 0.105). CONCLUSION Skeletal muscle mass decreases during neoadjuvant chemotherapy. Skeletal muscle loss during neoadjuvant chemotherapy impairs the conditions for adjuvant chemotherapy.
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Affiliation(s)
- Sam Eriksson
- Department of Clinical Sciences Lund, Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Jan H Nilsson
- Department of Clinical Sciences Lund, Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Peter Strandberg Holka
- Department of Clinical Sciences Lund, Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Jakob Eberhard
- Department of Clinical Sciences Lund, Oncology, Lund University, Skane University Hospital, Lund, Sweden
| | - Inger Keussen
- Department of Clinical Sciences Lund, Radiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Christian Sturesson
- Department of Clinical Sciences Lund, Surgery, Lund University, Skane University Hospital, Lund, Sweden.
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30
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Sturesson C, Valdimarsson VT, Blomstrand E, Eriksson S, Nilsson JH, Syk I, Lindell G. Liver-first strategy for synchronous colorectal liver metastases - an intention-to-treat analysis. HPB (Oxford) 2017; 19:52-58. [PMID: 27838252 DOI: 10.1016/j.hpb.2016.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 08/14/2016] [Revised: 10/02/2016] [Accepted: 10/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The liver-first strategy signifies resection of liver metastases before the primary colorectal cancer. The aim of the present study was to compare failure to complete intended treatment and survival in liver-first and classical strategies. METHODS All patients with colorectal cancer and synchronous liver metastases planned for sequential radical surgery in a single institution between 2011 and 2015 were included. RESULTS A total of 109 patients were presented to a multidisciplinary team conference (MDT) with un-resected colorectal cancer and synchronous liver metastases. Seventy-five patients were planned as liver-first, whereas 34 were recommended the classical strategy. Twenty-six patients (35%) failed to complete treatment in the liver-first group compared to 10 patients in the classical group (P = 0.664). Reason for failure was most commonly disease progression. A total of 91 patients had the primary tumor resected before the liver metastases of which 67 before referral and 24 after allocation at MDT. Median survival after diagnosis in this group was 60 (48-73) months compared to 46 (31-60) months in the group operated with liver-first strategy (n = 49), (P = 0.310). DISCUSSION Up to 35% of patients with colorectal cancer and synchronous liver metastases do not complete the intended treatment of liver and bowel resections, irrespective of treatment strategy.
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Affiliation(s)
- Christian Sturesson
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden.
| | - Valentinus T Valdimarsson
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden
| | - Erik Blomstrand
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden
| | - Sam Eriksson
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden
| | - Jan H Nilsson
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden
| | - Ingvar Syk
- Lund University, Skane University Hospital, Department of Clinical Sciences Malmö, Surgery, Malmö, Sweden
| | - Gert Lindell
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden
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Nilsson JH, Reistad N, Brange H, Öberg CF, Sturesson C. Diffuse Reflectance Spectroscopy for Surface Measurement of Liver Pathology. Eur Surg Res 2016; 58:40-50. [PMID: 27658312 DOI: 10.1159/000449378] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/23/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver parenchymal injuries such as steatosis, steatohepatitis, fibrosis, and sinusoidal obstruction syndrome can lead to increased morbidity and liver failure after liver resection. Diffuse reflectance spectroscopy (DRS) is an optical measuring method that is fast, convenient, and established. DRS has previously been used on the liver with an invasive technique consisting of a needle that is inserted into the parenchyma. We developed a DRS system with a hand-held probe that is applied to the liver surface. In this study, we investigated the impact of the liver capsule on DRS measurements and whether liver surface measurements are representative of the whole liver. We also wanted to confirm that we could discriminate between tumor and liver parenchyma by DRS. MATERIALS AND METHODS The instrumentation setup consisted of a light source, a fiber-optic contact probe, and two spectrometers connected to a computer. Patients scheduled for liver resection due to hepatic malignancy were included, and DRS measurements were performed on the excised liver part with and without the liver capsule and alongside a newly cut surface. To estimate the scattering parameters and tissue chromophore volume fractions, including blood, bile, and fat, the measured diffuse reflectance spectra were applied to an analytical model. RESULTS In total, 960 DRS spectra from the excised liver tissue of 18 patients were analyzed. All factors analyzed regarding tumor versus liver tissue were significantly different. When measuring through the capsule, the blood volume fraction was found to be 8.4 ± 3.5%, the lipid volume fraction was 9.9 ± 4.7%, and the bile volume fraction was 8.2 ± 4.6%. No differences could be found between surface measurements and cross-sectional measurements. In measurements with/without the liver capsule, the differences in volume fraction were 1.63% (0.75-2.77), -0.54% (-2.97 to 0.32), and -0.15% (-1.06 to 1.24) for blood, lipid, and bile, respectively. CONCLUSION This study shows that it is possible to manage DRS measurements through the liver capsule and that surface DRS measurements are representative of the whole liver. The results are consistent with data published earlier on the combination of liver chromophores. The results encourage us to proceed with in vivo measurements for further quantification of the liver's composition and assessment of parenchymal damage such as steatosis and fibrosis grade.
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Affiliation(s)
- Jan H Nilsson
- Department of Clinical Sciences Lund, Surgery, Skåne University Hospital, Lund University, Lund, Sweden
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Ansari D, Tingstedt B, Andersson B, Holmquist F, Sturesson C, Williamsson C, Sasor A, Borg D, Bauden M, Andersson R. Pancreatic cancer: yesterday, today and tomorrow. Future Oncol 2016; 12:1929-46. [PMID: 27246628 DOI: 10.2217/fon-2016-0010] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [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: 12/13/2022] Open
Abstract
Pancreatic cancer is one of our most lethal malignancies. Despite substantial improvements in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since the 1960s. Pancreatic cancer is usually detected at an advanced stage and most treatment regimens are ineffective, contributing to the poor overall prognosis. Herein, we review the current understanding of pancreatic cancer, focusing on central aspects of disease management from radiology, surgery and pathology to oncology.
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Affiliation(s)
- Daniel Ansari
- Department of Surgery, Clinical Sciences Lund, Lund University & Skåne University Hospital, Lund, Sweden
| | - Bobby Tingstedt
- Department of Surgery, Clinical Sciences Lund, Lund University & Skåne University Hospital, Lund, Sweden
| | - Bodil Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University & Skåne University Hospital, Lund, Sweden
| | - Fredrik Holmquist
- Department of Radiology, Clinical Sciences Lund, Lund University & Skåne University Hospital, Lund, Sweden
| | - Christian Sturesson
- Department of Surgery, Clinical Sciences Lund, Lund University & Skåne University Hospital, Lund, Sweden
| | - Caroline Williamsson
- Department of Surgery, Clinical Sciences Lund, Lund University & Skåne University Hospital, Lund, Sweden
| | - Agata Sasor
- Department of Pathology, Skåne University Hospital, Lund, Sweden
| | - David Borg
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Monika Bauden
- Department of Surgery, Clinical Sciences Lund, Lund University & Skåne University Hospital, Lund, Sweden
| | - Roland Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University & Skåne University Hospital, Lund, Sweden
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Nilsson JH, Strandberg Holka P, Sturesson C. Incisional hernia after open resections for colorectal liver metastases - incidence and risk factors. HPB (Oxford) 2016; 18:436-41. [PMID: 27154807 PMCID: PMC4857068 DOI: 10.1016/j.hpb.2016.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 12/28/2015] [Accepted: 02/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Incisional hernia is one of the most common complications after laparotomy. The aim of this retrospective study was to investigate incidence, location and risk factors for incisional hernia after open resection for colorectal liver metastases including the use of perioperative chemotherapy and targeted therapy evaluated by computed tomography. METHODS Patients operated for colorectal liver metastases between 2010 and 2013 were included. Incisional hernia was defined as a discontinuity in the abdominal fascia observed on computed tomography. RESULTS A total of 256 patients were analyzed in regard to incisional hernia. Seventy-eight patients (30.5%) developed incisional hernia. Hernia locations were midline alone in 66 patients (84.6%) and involving the midline in another 8 patients (10.3%). In multivariate analysis, preoperative chemotherapy >6 cycles (hazard ratio 2.12, 95% confidence interval 1.14-3.94), preoperative bevacizumab (hazard ratio 3.63, 95% confidence interval 1.86-7.08) and incisional hernia from previous surgery (hazard ratio 3.50, 95% confidence interval 1.98-6.18) were found to be independent risk factors. CONCLUSIONS Prolonged preoperative chemotherapy and also preoperative bevacizumab were strong predictors for developing an incisional hernia. After an extended right subcostal incision, the hernia location was almost exclusively in the midline.
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Affiliation(s)
- Jan H. Nilsson
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Peter Strandberg Holka
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Christian Sturesson
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden,Correspondence Department of Surgery, Skåne University Hospital, S-221 85 Lund, Sweden. Tel: +46 46 172347. Fax: +46 46 172335.
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Sturesson C, Nilsson J, Lindell G, Andersson RG, Keussen I. Disappearing liver metastases from colorectal cancer: impact of modern imaging modalities. HPB (Oxford) 2015; 17:983-7. [PMID: 26252426 PMCID: PMC4605336 DOI: 10.1111/hpb.12476] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 05/01/2015] [Accepted: 06/17/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chemotherapy is often used before a resection for colorectal liver metastases. After chemotherapy, metastases may disappear on cross-sectional imaging but residual metastatic disease may still exist. The aim of this retrospective study was to investigate the impact of new advancements in imaging technology such as magnetic resonance imaging (MRI) with liver-specific contrast (Gd-EOB-DTPA) and contrast-enhanced intra-operative ultrasound (CE-IOUS) on disappearing liver metastases (DLM). METHODS Twenty-nine patients with one or more DLM undergoing surgical exploration were included. Pre-operative imaging consisted of contrast-enhanced multi-detector computed tomography (MDCT) and/or MRI with liver-specific contrast. At surgery, CE-IOUS was used when tumours known from pre-chemotherapy imaging were not found by inspection or intra-operative ultrasound. RESULTS Patients presented 66 DLM. At surgical exploration, 42 DLM were identified and treated (64%). CE-IOUS detected one additional DLM not found by intra-operative ultrasound. For metastases ≤10 mm on histological analysis, imaging sensitivities for MRI and MDCT before surgery but after chemotherapy were 26/49 (53%) and 24/66 (36%), respectively. CONCLUSION A majority of DLM are identified during surgery using intra-operative ultrasound, with only little additional value of CE-IOUS. The sensitivities of post-chemotherapy imaging modalities for small metastases are low in the setting of DLM. For surgical planning, an optimized pre-chemotherapy imaging is essential.
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Affiliation(s)
- Christian Sturesson
- Department of Clinical Sciences, Lund, Surgery, Lund University, Skåne University HospitalLund, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences, Lund, Surgery, Lund University, Skåne University HospitalLund, Sweden
| | - Gert Lindell
- Department of Clinical Sciences, Lund, Surgery, Lund University, Skåne University HospitalLund, Sweden
| | - Roland G Andersson
- Department of Clinical Sciences, Lund, Surgery, Lund University, Skåne University HospitalLund, Sweden
| | - Inger Keussen
- Department of Radiology, Lund University, Skåne University HospitalLund, Sweden
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Williamsson C, Karlsson N, Sturesson C, Lindell G, Andersson R, Tingstedt B. Impact of a fast-track surgery programme for pancreaticoduodenectomy. Br J Surg 2015; 102:1133-41. [PMID: 26042725 DOI: 10.1002/bjs.9856] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/12/2015] [Accepted: 04/14/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Fast-track (FT) programmes are multimodal, evidence-based approaches to optimize patient outcome after surgery. The aim of this study was to evaluate the safety, clinical outcome and patients' experience of a FT programme after pancreaticoduodenectomy (PD) in a high-volume institution in Sweden. METHODS Consecutive patients undergoing PD were studied before and after implementation of the FT programme. FT changes included earlier mobilization, standardized removal of the nasogastric tube and drain, and earlier start of oral intake. Patient experience was evaluated with European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-PAN26 questionnaires 2 weeks before and 4 weeks after surgery. RESULTS Between 2011 and 2014, 100 consecutive patients undergoing PD were studied, of whom 50 received standard care (controls), followed by 50 patients treated after implementation of the FT programme. The nasogastric tube was removed significantly earlier in the FT group, and these patients were able fully to tolerate fluids and solid food sooner after PD. Delayed gastric emptying was significantly reduced in the FT group (26 versus 48 per cent; P = 0.030). Overall morbidity remained unchanged and there were no deaths in either group. Postoperative length of hospital stay was reduced from 14 to 10 days and hospital costs were decreased significantly. Health-related quality-of-life questionnaires showed similar patterns of change, with no significant difference between groups before or after surgery. CONCLUSION The FT programme after PD was safe. Delayed gastric emptying, hospital stay and hospital costs were all reduced significantly. Although patients were discharged 4 days earlier in the FT group, this did not influence health-related quality of life compared with standard care.
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Affiliation(s)
- C Williamsson
- Department of Surgery, Skåne University Hospital at Lund, Lund, Sweden
| | - N Karlsson
- Department of Surgery, Skåne University Hospital at Lund, Lund, Sweden
| | - C Sturesson
- Department of Surgery, Skåne University Hospital at Lund, Lund, Sweden
| | - G Lindell
- Department of Surgery, Skåne University Hospital at Lund, Lund, Sweden
| | - R Andersson
- Department of Surgery, Skåne University Hospital at Lund, Lund, Sweden
| | - B Tingstedt
- Department of Surgery, Skåne University Hospital at Lund, Lund, Sweden
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Spelt L, Sparrelid E, Isaksson B, Andersson RG, Sturesson C. Tumour growth after portal vein embolization with pre-procedural chemotherapy for colorectal liver metastases. HPB (Oxford) 2015; 17:529-35. [PMID: 25726854 PMCID: PMC4430784 DOI: 10.1111/hpb.12397] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 10/09/2014] [Accepted: 12/24/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND For resection of colorectal cancer (CRC) liver metastases, pre-operative portal vein embolization (PVE) is used to increase the size of the future liver remnant (FLR) prior to advanced liver resection when indicated. PVE is speculated to cause tumour progression, but only a limited number of studies have analysed tumour growth after PVE in the context of pre-procedural chemotherapy, which was the aim of this retrospective study. METHODS Patients treated with stabilizing chemotherapy and PVE before liver resection for CRC metastases were included. Tumour progression according to RECIST guidelines and a change in tumour volume was analysed on computed tomography (CT) scans prior to chemotherapy, before PVE and after PVE, respectively. RESULTS Thirty-four patients were included, of whom 23 had bilobar disease. Of tumours in the embolized lobe, 3/34 showed progression after PVE as compared with 3/23 in the non-embolized lobe (P = 0.677). A decrease in tumour volume of 16% and 11% was noted in the embolized and non-embolized lobe, respectively (P = 0.368). Patients were off chemotherapy in a median of 16 days before PVE. There was a linear correlation between the growth of tumours and time between the end of chemotherapy and PVE (r = 0.25, P = 0.0005). CONCLUSION The rate of progression of CRC liver metastases after PVE and pre-procedural chemotherapy was lower in the present study as compared with previous reports. This applies to tumours in both the embolized and non-embolized lobes and is associated with keeping the time between the end of chemotherapy and PVE short.
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Affiliation(s)
- Lidewij Spelt
- Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University HospitalLund, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska University Hospital, Karolinska InstitutetStockholm, Sweden
| | - Bengt Isaksson
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska University Hospital, Karolinska InstitutetStockholm, Sweden
| | - Roland G Andersson
- Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University HospitalLund, Sweden
| | - Christian Sturesson
- Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University HospitalLund, Sweden,Correspondence Christian Sturesson, Department of Surgery, Skåne University Hospital, S-221 85 Lund, Sweden. Tel: +46 46 172347. Fax: +46 46 172335. E-mail:
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Nilsson J, Eriksson S, Nørgaard Larsen P, Keussen I, Christiansen Frevert S, Lindell G, Sturesson C. Concurrent biliary drainage and portal vein embolization in preparation for extended hepatectomy in patients with biliary cancer. Acta Radiol Open 2015; 4:2058460115579121. [PMID: 25992300 PMCID: PMC4433626 DOI: 10.1177/2058460115579121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/04/2015] [Indexed: 01/04/2023] Open
Abstract
Background Patients with perihilar cholangiocarcinoma and gallbladder cancer extending into the hilum often present with jaundice and a small future liver remnant (FLR). If resectable, preoperative biliary drainage and portal vein embolization (PVE) are indicated. Classically, these measures have been performed sequentially, separated by 4–6 weeks. Purpose To report on a new regime where percutaneous transhepatic biliary drainage (PTBD) and PVE are performed simultaneously, shortening the preoperative process. Material and Methods Six patients were treated with concurrent PTBD and PVE under general anesthesia. Results Surgical exploration followed the combined procedure after 35 days (range, 28–51 days). The FLR ratio increased from 22% to 32%. Three patients developed cholangitis after the procedure. Conclusion The combined approach of PTBD and PVE seems feasible, but more studies on morbidity are warranted.
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Affiliation(s)
- Jan Nilsson
- Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sam Eriksson
- Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peter Nørgaard Larsen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Denmark
| | - Inger Keussen
- Department of Radiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Susanne Christiansen Frevert
- Department of Vascular and Interventional Radiology, Rigshospitalet, Faculty of Health Sciences, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Gert Lindell
- Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Christian Sturesson
- Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Denmark
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Sturesson C, Hoekstra L, Andersson R, van Gulik TM. Importance of thrombocytes for the hypertrophy response after portal vein embolization. Hepatogastroenterology 2015; 62:98-101. [PMID: 25911876 DOI: 10.5754/hge12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND/AIMS Thrombocytes have proved to be important for liver regeneration after liver resection in the experimental setting. The aim of our study is to examine the effects of thrombocytes on liver hypertrophy after portal vein embolization (PVE). METHODOLOGY This retrospective cohort study comprised 75 patients with liver metastases from colorectal cancer subjected to PVE in preparation for major liver resection. Patients were divided into 2 groups depending on if chemotherapy was given within 6 weeks before PVE or not. RESULTS The chemotherapy group showed lower levels of thrombocytes (p=0.003) and lower degree of hypertrophy (p=0.030) as compared to the group without chemotherapy. No correlation within groups between level of thrombocytes and degree of hypertrophy was found. However, in the chemotherapy group, a positive linear correlation between the degree of hypertrophy and the difference in thrombocytes between the time points of PVE and 2 months preceding PVE was found (p=0.0006). DISCUSSION Preprocedural chemotherapy results in decreased hypertrophy of the liver after PVE and lower levels of thrombocytes at the time for PVE. The absolute number of thrombocytes does not influence liver regeneration after PVE. For patients receiving preprocedural chemotherapy, PVE performed at a time when thrombocytes are decreasing is associated with a reduced regeneration.
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Abstract
Microcirculation plays a crucial role in physiological processes of tissue oxygenation and nutritional exchange. Measurement of microcirculation can be applied on many organs in various pathologies. In this paper we aim to review the technique of non-invasive methods for imaging of the microcirculation. Methods covered are: videomicroscopy techniques, laser Doppler perfusion imaging, and laser speckle contrast imaging. Videomicroscopy techniques, such as orthogonal polarization spectral imaging and sidestream dark-field imaging, provide a plentitude of information and offer direct visualization of the microcirculation but have the major drawback that they may give pressure artifacts. Both laser Doppler perfusion imaging and laser speckle contrast imaging allow non-contact measurements but have the disadvantage of their sensitivity to motion artifacts and that they are confined to relative measurement comparisons. Ideal would be a non-contact videomicroscopy method with fully automatic analysis software.
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Affiliation(s)
- Sam Eriksson
- Department of Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden ; Skåne University Hospital, Lund, Sweden
| | - Jan Nilsson
- Department of Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden ; Skåne University Hospital, Lund, Sweden
| | - Christian Sturesson
- Department of Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden ; Skåne University Hospital, Lund, Sweden
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Blind PJ, Andersson B, Tingstedt B, Bergenfeldt M, Andersson R, Lindell G, Sturesson C. Fast-track program for liver resection--factors prolonging length of stay. Hepatogastroenterology 2014; 61:2340-2344. [PMID: 25699379 DOI: 10.5754/hge13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND/AIMS Fast-track programs involving multi-modal measures to enhance recovery after surgery, reduce morbidity and decrease hospital length of stay (LOS) are used for different major surgical procedures. For liver resections, factors influencing LOS within a fast-track program have been studied only to a limited extent, which was the aim of the present study. METHODOLOGY The present study comprises the first 64 patients included in a fast-track program for liver resections introduced in March 2012. Patient outcomes were compared to a historical cohort of patients (n=62) operated in 2009. Factors prolonging LOS was analyzed by uni- and multivariate analysis. RESULTS Median LOS was 6 days (range 3-42 days) within the fast-track program as compared with 8 days (range 5-47 days) in the historical cohort (P=0.004). On multivariate analysis, factors increasing LOS in the fast-track group were found to be the presence of complication (P=0.018), extent of resection (major as compared to minor) (P=0.001) and inability to drink > 1250 ml on the day after surgery (P=0.002). CONCLUSION Patients who can only drink limited amounts of fluid the day after liver resection represent a subset of patients that should be given special attention within a fast-track program.
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Eriksson S, Nilsson J, Lindell G, Sturesson C. Laser speckle contrast imaging for intraoperative assessment of liver microcirculation: a clinical pilot study. Med Devices (Auckl) 2014; 7:257-61. [PMID: 25114599 PMCID: PMC4122554 DOI: 10.2147/mder.s63393] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Liver microcirculation can be affected by a wide variety of causes relevant to liver transplantation and resectional surgery. Intraoperative assessment of the microcirculation could possibly predict postoperative outcome. The present pilot study introduces laser speckle contrast imaging (LSCI) as a new clinical method for assessing liver microcirculation. Methods LSCI measurements of liver microcirculation were performed on ten patients undergoing liver resection. Measurements were made during apnea with and without liver blood inflow occlusion. Hepatic blood flow was assessed by subtracting zero inflow signal from the total signal. Zero inflow signal was obtained after hepatic artery and portal vein occlusion. Perfusion was expressed in laser speckle perfusion units, and intraindividual and interindividual variability in liver perfusion was investigated using the coefficient of variability. Results Hepatic microcirculation measurements were successfully made in all patients resulting in analyzable speckle contrast images. Mean hepatic blood flow was 410±36 laser speckle perfusion units. Zero inflow signal amounted to 40%±4% of the total signal. Intraindividual and interindividual coefficients of variability in liver perfusion were 25% and 28%, respectively. Conclusion Under the conditions of this pilot study, LSCI allows rapid noncontact measurements of hepatic blood perfusion over wide areas. More studies are needed on methods of handling movement artifacts.
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Affiliation(s)
- Sam Eriksson
- Department of Surgery, Clinical Sciences Lund, Lund University, Sweden ; Skåne University Hospital, Lund, Sweden
| | - Jan Nilsson
- Department of Surgery, Clinical Sciences Lund, Lund University, Sweden ; Skåne University Hospital, Lund, Sweden
| | - Gert Lindell
- Department of Surgery, Clinical Sciences Lund, Lund University, Sweden ; Skåne University Hospital, Lund, Sweden
| | - Christian Sturesson
- Department of Surgery, Clinical Sciences Lund, Lund University, Sweden ; Skåne University Hospital, Lund, Sweden
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Sturesson C, Ivarsson K, Andersson-Engels S, Tranberg KG. Changes in Local Hepatic Blood Perfusion During Interstitial Laser-Induced Thermotherapy of Normal Rat Liver Measured by Interstitial Laser Doppler Flowmetry. Lasers Med Sci 2014; 14:143-9. [DOI: 10.1007/s101030050036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sturesson C, Nilsson J, Eriksson S, Spelt L, Andersson R. Limiting factors for liver regeneration after a major hepatic resection for colorectal cancer metastases. HPB (Oxford) 2013; 15:646-52. [PMID: 23458360 PMCID: PMC3731588 DOI: 10.1111/hpb.12040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 08/10/2012] [Accepted: 11/28/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chemotherapy before resection of colorectal metastases in the liver is extensively used and has been shown to induce histopathological changes in the liver parenchyma, although little is known about the effect of chemotherapy on liver regeneration. The aim of this study was to determine if pre-operative chemotherapy influences the regenerated liver volume after a major liver resection. PATIENTS AND METHODS This retrospective cohort study included 74 patients subjected to a major liver resection for colorectal metastases. Patients were divided into two groups depending on whether they had been treated with chemotherapy less than 3 months before surgery or not. Liver volumes were measured before and 1 year after resection. RESULTS Pre-operative chemotherapy reduced volumetric liver regeneration (83 ± 2% versus 91 ± 2%; P = 0.007) as compared with patients without chemotherapy. There was a linear correlation between regenerated volume and time interval between the end of chemotherapy to resection (P = 0.031). CONCLUSIONS Pre-operative chemotherapy in patients with colorectal liver metastases negatively affects volume regeneration after a partial hepatectomy. The time interval between chemotherapy and surgery determines the impact of these affects.
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Affiliation(s)
- Christian Sturesson
- Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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Abstract
BACKGROUND Fast-track (FT) programmes represent a series of multimodal concepts that may reduce surgical stress and speed up convalescence after surgery. The aim of this systematic review was to evaluate FT programmes for patients undergoing hepatopancreatic surgery. METHODS PubMed, Embase and the Cochrane Library databases were searched for studies of FT vs. conventional recovery strategies for liver and pancreatic resections. RESULTS For liver surgery, three cohort studies were included. Primary hospital stay was significantly reduced after FT care in two of the three studies. There were no significant differences in rates of readmission, morbidity and mortality. For pancreatic surgery, three cohort studies and one case-control study were included. Primary hospital stay was significantly shorter after FT care in three out of the four studies. One study reported a significantly decreased readmission rate (7% vs. 25%; P= 0.027), and another study showed lower morbidity (47.2% vs. 58.7%; P < 0.01) in favour of the FT group. There was no difference in mortality between the FT and control groups. CONCLUSIONS FT rehabilitation for liver and pancreatic surgical patients is feasible. Future investigation should focus on optimizing individual elements of the FT programme within the context of liver and pancreatic surgery.
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Affiliation(s)
- Lidewij Spelt
- Department of Surgery, Clinical Sciences Lund, Skåne University Hospital Lund and Lund University, Sweden
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Sturesson C, Ivarsson K, Stenram U, Andersson-Engels S, Tranberg KG. Interstitial laser thermotherapy of a rat liver tumour: effect of hepatic inflow occlusion. Lasers Surg Med 2011; 43:29-35. [PMID: 21254140 DOI: 10.1002/lsm.21024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Interstitial laser thermotherapy was used to treat rat liver tumours. The aim was to investigate the influence of temperature and temporary hepatic inflow occlusion on tumour growth and blood perfusion. STUDY DESIGN/MATERIALS AND METHODS Liver tumours were treated at 44°C at the tumour border for 30 minutes, hepatic inflow occlusion only, or a combination of these methods. Interstitial laser Doppler flowmetry was used to measure hepatic perfusion at the tumour border during and after heat treatment, for a total time of 60 minutes. Tumour growth was evaluated 6 days after treatment. RESULTS Tumours subjected to the combined treatment of hepatic inflow occlusion and interstitial laser thermotherapy displayed a blood perfusion reduction 30 minutes after treatment to 18 ± 5% of initial perfusion, which was significantly lower than achieved with thermotherapy alone (52 ± 10%, P = 0.02). The combined treatment and treatment with thermotherapy alone resulted in relative tumour growth of 0.3 ± 0.1 and 1.0 ± 0.2, respectively (P = 0.04). CONCLUSION Inflow occlusion enhanced the effect of thermotherapy not by augmenting treatment temperatures but by increasing the thermal sensitivity of the tumour, reflected by an immediate effect on tumour blood perfusion.
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Affiliation(s)
- Christian Sturesson
- Department of Surgery, Clinical Sciences Lund, Lund University, SE-221 85 Lund, Sweden.
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Björk Werner J, Sturesson C, Dawiskiba S, Andersson R. Mucinous cystadenocarcinoma of the pancreas - outcome following different modes of treatment. Ann Gastroenterol 2011; 24:213-217. [PMID: 24713784 PMCID: PMC3959310] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 05/18/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Mucinous cystadenocarcinomas (MCAC) of the pancreas are rare tumors. When localized to the pancreas alone, surgical resection is mostly associated with a favorable prognosis. The potential value of palliative treatment with chemotherapy for irresectable disease is scarcely described though. The aim of this study was to describe a single-center series of patients with MCAC of the pancreas focusing on the outcome following different treatment strategies. METHODS 15 patients, 10 females and 5 males, with histologically or cytologically verified MCAC, were divided into three groups: surgical resection (n=7), chemotherapy (n=5) and no treatment (n=3). RESULTS There was no obvious difference in gender distribution between the subgroups. A tendency towards higher age was seen in the group without treatment, as was a larger tumor size as compared to the chemotherapy group. Patients were administered chemotherapy and the group without treatment seemed to present with the same prevalence of metastatic disease (3/5 and 2/3, respectively). All patients in the group without treatment died after in median 1 month following pathological diagnosis. One patient in the chemotherapy group was alive at 9-month follow up, and the others survived a median of 11 months. In the surgically treated group, 4/7 were alive at follow-up of a median of 154 months. Of the three deceased patients who had survived 44, 53 and 151 months, respectively, two had microscopically non-radical resection. CONCLUSIONS MCAC of the pancreas is, when locally confined and without metastases, associated with fairly good prognosis after surgical resection. In inoperable patients and for metastatic disease, outcome is poor.
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Affiliation(s)
- Josefin Björk Werner
- Departments of Surgery Clinical Sciences Lund, Lund University and Skåne University Hospital Lund (Josefin Björk Werner, Christian Sturesson, Roland Andersson)
| | - Christian Sturesson
- Departments of Surgery Clinical Sciences Lund, Lund University and Skåne University Hospital Lund (Josefin Björk Werner, Christian Sturesson, Roland Andersson)
| | - Sigmund Dawiskiba
- Pathology and Cytology, Clinical Sciences Lund, Lund University and Skåne University Hospital Lund (Sigmund Dawiskiba)
| | - Roland Andersson
- Departments of Surgery Clinical Sciences Lund, Lund University and Skåne University Hospital Lund (Josefin Björk Werner, Christian Sturesson, Roland Andersson)
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Ivarsson K, Sturesson C, Stenram U, Tranberg KG. Linomide improves the effect of interstitial laser thermotherapy in a rat liver tumour model. Anticancer Res 2003; 23:1257-63. [PMID: 12820380] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
AIM The aim of this study was to investigate if Linomide affects growth and spread of a rat liver tumour when given alone and in combination with interstitial laser thermotherapy (ILT). MATERIALS AND METHODS Experiments were performed in Wistar rats using a dimethyl-hydrazine-induced adenocarcinoma implanted into the left lateral lobe of the liver. The rats were randomised to one of the following groups: a) ILT and Linomide, b) ILT only, c) sham ILT, d) Linomide only, or e) control. ILT was intentionally suboptimal. Linomide (100 mg/kg/day) was given in the drinking water from the start of treatment for five days. ED1, ED2 macrophages and v Willebrand (factor VIII) were determined by an immunohistochemical technique. RESULTS Linomide reduced viable liver tumour volume both when it was given alone (p < 0.01) and when combined with ILT (p < 0.05), whereas it lowered intraperitoneal spread in ILT-treated rats alone. Six days after ILT, there was a reduction in the number of newly-recruited macrophages and blood vessels in the viable tumour tissue in rats receiving Linomide. CONCLUSION Linomide reduced the growth of an adenocarcinoma transplanted into rat liver, when given alone or combined with laser thermotherapy and reduced the spread of tumour in laser-treated rats. The effects of Linomide in laser-treated rats appeared, at least in part, to be due to a reduction in newly-formed vessels, which might have been secondary to a reduced number of tumour-associated macrophages.
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Affiliation(s)
- Kjell Ivarsson
- Department of Surgery, Lund University, SE-22185 Lund, Sweden
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Sturesson C, Degling Wikingsson L. Comparison of poly(acryl starch) and poly(lactide-co-glycolide) microspheres as drug delivery system for a rotavirus vaccine. J Control Release 2000; 68:441-50. [PMID: 10974398 DOI: 10.1016/s0168-3659(00)00294-7] [Citation(s) in RCA: 48] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Drug delivery systems allowing controlled release of antigen are of particular interest in the development of vaccines. We have compared poly(acrylic starch) microspheres (PAS) and poly(lactide-co-glycolide) microspheres (PLG) as drug delivery systems for a rotavirus vaccine. The polymers are both biodegradable but have different degradation mechanisms and antigen release profiles. PAS are enzymatically degraded and have a continuous fast antigen release rate compared to the hydrolytically degraded PLG which release the incorporated antigen in a pulsatile manner. In this study mice were immunised intramuscularly and orally on three occasions with formalin-inactivated rotavirus (FRRV) incorporated in PAS and PLG and with FFRV alone. Serum and faeces samples were collected and analysed by ELISA for rotavirus specific IgG and IgA antibodies. A neutralising assay was also conducted on both serum and faeces antibodies. The two different polymer drug delivery systems induced different immune responses depending on administration route. PAS elicited significant antibody levels and neutralising effect after oral administration while PLG showed high antibody levels after intramuscular administration. The immune response appears to be dependent on the differences in antigen release and degradation mechanism for the two polymer systems.
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Affiliation(s)
- C Sturesson
- Department of Pharmacy, Uppsala University, Box 580, SE-751 23, Uppsala, Sweden
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Abstract
The enzyme urease was incorporated into poly(lactide-co-glycolide) microspheres using a double emulsion solvent removal technique. Ethyl acetate was used as organic solvent since it is less toxic than the more commonly used methylene chloride. The effect of the two solvents on urease was compared. Although this preparation technique is well established, it is often associated with reduced bioactivity and low entrapment efficiency of proteins. In order to retain a high degree of bioactivity, the well known protein stabilisers: sucrose, trehalose and poloxamer 407, were added to the urease in the preparation. The bioactivity of the entrapped urease was reduced more by methylene chloride than by ethyl acetate. The gelled form of poloxamer was shown to highly favour the retention of bioactivity, demonstrated by an increase of 41% compared to preparations without poloxamer. Moreover, the presence of poloxamer strongly increased the in vitro release rate of urease from the microspheres. The entrapment efficiency was increased by 44% using the sugars in the preparation. These results clearly show the great potential of small quantities of additive in the formulation to control the properties of the microspheres. The amount and type of additive could be adjusted according to the therapeutic application of the preparation.
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Affiliation(s)
- C Sturesson
- Department of Pharmacy, Uppsala University, Box 580, SE-751 23, Uppsala, Sweden
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Abstract
BACKGROUND AND OBJECTIVE The size of laser-induced coagulated lesions produced in porcine muscle in vitro using a cylindrical diffusing fiber tip and a conductive heat source, made by covering the diffuser with a hollow steel needle, were compared to investigate the influence of charring. MATERIALS AND METHODS Light from a Nd:YAG laser was utilized for thermotherapy. A theoretical model for calculating tissue temperature was used to predict the experimental results and to simulate in vivo treatments. RESULTS The metal-covered tip produced carbonization and tissue vaporization that was not found with the diffuser. After 20 min of irradiation at a laser power of 7 W, the coagulated volumes with and without carbonization were found to be 13.1 cm3 (range 12.4-14.1 cm3, n = 4) and 12.2 cm3 (range 11.5-13.4 cm3, n = 4), respectively. Mathematical simulations showed that in unperfused tissue, a diffusing laser heat source produces smaller lesions than does a conductive heat source at the same power, the difference in coagulated volume becoming smaller with increased treatment time and increased power. CONCLUSION Using cylindrical diffusers, interstitial laser-induced thermotherapy without carbonization at the fiber tip can be as efficient as treatment with carbonization.
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Affiliation(s)
- C Sturesson
- Department of Physics, Lund Institute of Technology, Sweden.
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