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Arntz PJW, Olthof PB, Korenblik R, Heil J, Kazemier G, van Delden OM, Bennink RJ, Damink SWMO, van Dam RM, Schadde E, Erdmann JI. Effect of Sarcopenia on the Increase in Liver Volume and Function After Portal Vein Embolization. Cardiovasc Intervent Radiol 2024; 47:642-649. [PMID: 38416177 DOI: 10.1007/s00270-024-03676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Sarcopenia is associated with a decreased kinetic growth rate (KGR) of the future liver remnant (FLR) after portal vein embolization (PVE). However, little is known on the increase in FLR function (FLRF) after PVE. This study evaluated the effect of sarcopenia on the functional growth rate (FGR) after PVE measured with hepatobiliary scintigraphy (HBS). METHODS All patients who underwent PVE at the Amsterdam UMC between January 2005 and August 2017 were analyzed. Functional imaging by HBS was used to determine FGR. Liver volumetry was performed using multiphase contrast computed tomography (CT). Muscle area measurement to determine sarcopenia was taken at the third lumbar level (L3). RESULTS Out of the 95 included patients, 9 were excluded due to unavailable data. 70/86 (81%) patients were sarcopenic. In the multivariate logistic regression analysis, sarcopenia (p = 0.009) and FLR volume (FRLV) before PVE (p = 0.021) were the only factors correlated with KGR, while no correlation was found with FGR. 90-day mortality was similar across the sarcopenic and non-sarcopenic group (4/53 [8%] versus 1/11 [9%]; p = 1.000). The resection rates were also comparable (53/70 [75%] versus 11/16 [69%]; p = 0.542). CONCLUSION FGR after PVE as measured by HBS appears to be preserved in sarcopenic patients. This is in contrast to KGR after PVE as measured by liver volumetry which is decreased in sarcopenic patients. LEVEL OF EVIDENCE Level 3b, cohort and case control studies.
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Affiliation(s)
- Pieter J W Arntz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pim B Olthof
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Remon Korenblik
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jan Heil
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany
| | - Geert Kazemier
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roelof J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven W M Olde Damink
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ronald M van Dam
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Erik Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of Surgery, Rush University Chicago, Chicago, IL, USA
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Kalil JA, Krzywon L, Zlotnik O, Perrier H, Petrillo SK, Chaudhury P, Schadde E, Metrakos P. Debulking Hepatectomy for Colorectal Liver Metastasis Conveys Survival Benefit. Cancers (Basel) 2024; 16:1730. [PMID: 38730684 PMCID: PMC11083421 DOI: 10.3390/cancers16091730] [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] [Received: 04/17/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Despite advances in surgical technique and systemic chemotherapy, some patients with multifocal, bilobar colorectal liver metastases (CRLM) remain unresectable. These patients may benefit from surgical debulking of liver tumors in combination with chemotherapy compared to chemotherapy alone. (2) Methods: A retrospective study including patients evaluated for curative intent resection of CRLM was performed. Patients were divided into three groups: those who underwent liver resection with recurrence within 6 months (subtotal debulked, SD), those who had the first stage only of a two-stage hepatectomy (partially debulked, PD), and those never debulked (ND). Kaplan-Meier survival curves and log-rank test were performed to assess the median survival of each group. (3) Results: 174 patients underwent liver resection, and 34 patients recurred within 6 months. Of the patients planned for two-stage hepatectomy, 35 underwent the first stage only. Thirty-two patients were never resected. Median survival of the SD, PD, and ND groups was 31 months, 31 months, and 19.5 months, respectively (p = 0.012); (4) Conclusions: Patients who underwent a debulking of CRLM demonstrated a survival benefit compared to patients who did not undergo any surgical resection. This study provides support for the evaluation of intentional debulking versus palliative chemotherapy alone in a randomized trial.
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Affiliation(s)
- Jennifer A. Kalil
- Department of Surgery, Royal Victoria Hospital—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada; (J.A.K.); (L.K.); (O.Z.); (H.P.); (P.C.)
- Cancer Research Program, Research Institute—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada;
| | - Lucyna Krzywon
- Department of Surgery, Royal Victoria Hospital—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada; (J.A.K.); (L.K.); (O.Z.); (H.P.); (P.C.)
| | - Oran Zlotnik
- Department of Surgery, Royal Victoria Hospital—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada; (J.A.K.); (L.K.); (O.Z.); (H.P.); (P.C.)
- Cancer Research Program, Research Institute—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada;
| | - Hugo Perrier
- Department of Surgery, Royal Victoria Hospital—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada; (J.A.K.); (L.K.); (O.Z.); (H.P.); (P.C.)
| | - Stephanie K. Petrillo
- Cancer Research Program, Research Institute—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada;
| | - Prosanto Chaudhury
- Department of Surgery, Royal Victoria Hospital—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada; (J.A.K.); (L.K.); (O.Z.); (H.P.); (P.C.)
- Cancer Research Program, Research Institute—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada;
| | - Erik Schadde
- Hepatobiliary and Pancreatic Surgery, Surgical Center in Zurich, Surgery Center St. Anna in Lucerne, Beausite Hospital in Berne, Hirslanden Corporation, Witteliker Str. 40, 8032 Zurich, Switzerland;
- Department of Surgery, Rush University Medical Center, 653 W Congress Pkwy 12, Chicago, IL 60612, USA
| | - Peter Metrakos
- Department of Surgery, Royal Victoria Hospital—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada; (J.A.K.); (L.K.); (O.Z.); (H.P.); (P.C.)
- Cancer Research Program, Research Institute—McGill University Health Center, 1001 Blvd Décarie, Montréal, QC H4A 3J1, Canada;
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Korenblik R, Heil J, Smits J, James S, Olij B, Bechstein WO, Bemelmans MHA, Binkert CA, Breitenstein S, Williams M, Detry O, Dewulf MJL, Dili A, Grochola LF, Grote J, Heise D, Kalil JA, Metrakos P, Neumann UP, Pappas SG, Pennetta F, Schnitzbauer AA, Tasse JC, Winkens B, Olde Damink SWM, van der Leij C, Schadde E, van Dam RM. Liver regeneration after portal and hepatic vein embolization improves overall survival compared with portal vein embolization alone: mid-term survival analysis of the multicentre DRAGON 0 cohort. Br J Surg 2024; 111:znae087. [PMID: 38662462 PMCID: PMC11044894 DOI: 10.1093/bjs/znae087] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The purpose of this study was to compare 3-year overall survival after simultaneous portal (PVE) and hepatic vein (HVE) embolization versus PVE alone in patients undergoing liver resection for primary and secondary cancers of the liver. METHODS In this multicentre retrospective study, all DRAGON 0 centres provided 3-year follow-up data for all patients who had PVE/HVE or PVE, and were included in DRAGON 0 between 2016 and 2019. Kaplan-Meier analysis was undertaken to assess 3-year overall and recurrence/progression-free survival. Factors affecting survival were evaluated using univariable and multivariable Cox regression analyses. RESULTS In total, 199 patients were included from 7 centres, of whom 39 underwent PVE/HVE and 160 PVE alone. Groups differed in median age (P = 0.008). As reported previously, PVE/HVE resulted in a significantly higher resection rate than PVE alone (92 versus 68%; P = 0.007). Three-year overall survival was significantly higher in the PVE/HVE group (median survival not reached after 36 months versus 20 months after PVE; P = 0.004). Univariable and multivariable analyses identified PVE/HVE as an independent predictor of survival (univariable HR 0.46, 95% c.i. 0.27 to 0.76; P = 0.003). CONCLUSION Overall survival after PVE/HVE is substantially longer than that after PVE alone in patients with primary and secondary liver tumours.
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Affiliation(s)
- Remon Korenblik
- GROW—School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jan Heil
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jens Smits
- GROW—School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Sinead James
- GROW—School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bram Olij
- GROW—School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Wolf O Bechstein
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Marc H A Bemelmans
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - Christoph A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Michael Williams
- Department of Surgery, Rush University Medical Center Chicago, Chicago, Illinois, USA
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, University of Liege, CHU Liege, Liege, Belgium
| | - Maxime J L Dewulf
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - Alexandra Dili
- Department of Abdominal Surgery, CHU-UC Louvain-Namur, Yvoir, Belgium
| | - Lukasz F Grochola
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Jon Grote
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Jennifer A Kalil
- Department of Surgery, Section of Hepato-pancreatico-biliary Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Peter Metrakos
- Department of Surgery, Section of Hepato-pancreatico-biliary Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Ulf P Neumann
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Sam G Pappas
- Department of Surgery, Rush University Medical Center Chicago, Chicago, Illinois, USA
| | - Francesca Pennetta
- GROW—School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Andreas A Schnitzbauer
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jordan C Tasse
- Department of Radiology, Rush University Medical Center Chicago, Chicago, Illinois, USA
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
- NUTRIM—School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Christiaan van der Leij
- GROW—School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Erik Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of Surgery, Rush University Medical Center Chicago, Chicago, Illinois, USA
- Surgical Centre, Hirslanden Clinic Zurich, Zurich, Switzerland
- Switzerland Surgical Centre, Hirslanden Clinic St Anna Luzern, Luzern, Switzerland
| | - Ronald M van Dam
- GROW—School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
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4
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Heil J, Augath M, Kurtcuoglu V, Hohmann J, Bechstein WO, Olthof P, Schnitzbauer AA, Seebeck P, Schiesser M, Schläpfer M, Beck-Schimmer B, Schadde E. Assessment of liver function by gadoxetic acid avidity in MRI in a model of rapid liver regeneration in rats. HPB (Oxford) 2024; 26:521-529. [PMID: 38185541 DOI: 10.1016/j.hpb.2023.12.007] [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: 09/06/2023] [Revised: 11/18/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND This animal study investigates the hypothesis of an immature liver growth following ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) by measuring liver volume and function using gadoxetic acid avidity in magnetic resonance imaging (MRI) in models of ALPPS, major liver resection (LR) and portal vein ligation (PVL). METHODS Wistar rats were randomly allocated to ALPPS, LR or PVL. In contrast-enhanced MRI scans with gadoxetic acid (Primovist®), liver volume and function of the right median lobe (=future liver remnant, FLR) and the deportalized lobes (DPL) were assessed until post-operative day (POD) 5. Liver functionFLR/DPL was defined as the inverse value of time from injection of gadoxetic acid to the blood pool-corrected maximum signal intensityFLR/DPL multiplied by the volumeFLR/DPL. RESULTS In ALPPS (n = 6), LR (n = 6) and PVL (n = 6), volumeFLR and functionFLR increased proportionally, except on POD 1. Thereafter, functionFLR exceeded volumeFLR increase in LR and ALPPS, but not in PVL. Total liver function was significantly reduced after LR until POD 3, but never undercuts 60% of its pre-operative value following ALPPS and PVL. DISCUSSION This study shows for the first time that functional increase is proportional to volume increase in ALPPS using gadoxetic acid avidity in MRI.
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Affiliation(s)
- Jan Heil
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Goethe University Frankfurt, University Hospital, Department of General, Visceral, Transplant and Thoracic Surgery, Germany
| | - Mark Augath
- Institute for Biomedical Engineering, ETH Zurich, Zurich, Switzerland
| | - Vartan Kurtcuoglu
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Joachim Hohmann
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland
| | - Wolf O Bechstein
- Goethe University Frankfurt, University Hospital, Department of General, Visceral, Transplant and Thoracic Surgery, Germany
| | - Pim Olthof
- Department of Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Andreas A Schnitzbauer
- Goethe University Frankfurt, University Hospital, Department of General, Visceral, Transplant and Thoracic Surgery, Germany
| | - Petra Seebeck
- Zurich Integrative Rodent Physiology (ZIRP), University of Zurich, Zurich, Switzerland
| | - Marc Schiesser
- Chirurgisches Zentrum Zürich (CZZ), Klinik Hirslanden Zurich, Zurich, Switzerland; Chirurgie Zentrum Zentralschweiz (CZZ) Hirslanden St. Anna, Lucerne, Switzerland
| | - Martin Schläpfer
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Institute of Anesthesiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Beatrice Beck-Schimmer
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Institute of Anesthesiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Erik Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Chirurgisches Zentrum Zürich (CZZ), Klinik Hirslanden Zurich, Zurich, Switzerland; Chirurgie Zentrum Zentralschweiz (CZZ) Hirslanden St. Anna, Lucerne, Switzerland; Department of Surgery, Rush University Medical Center Chicago, IL, USA.
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5
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Olthof PB, Erdmann JI, Alikhanov R, Charco R, Guglielmi A, Hagendoorn J, Hakeem A, Hoogwater FJH, Jarnagin WR, Kazemier G, Lang H, Maithel SK, Malago M, Malik HZ, Nadalin S, Neumann U, Olde Damink SWM, Pratschke J, Ratti F, Ravaioli M, Roberts KJ, Schadde E, Schnitzbauer AA, Sparrelid E, Topal B, Troisi RI, Groot Koerkamp B. Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible. Ann Surg Oncol 2024:10.1245/s10434-024-15115-0. [PMID: 38472674 DOI: 10.1245/s10434-024-15115-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/14/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND A right- or left-sided liver resection can be considered in about half of patients with perihilar cholangiocarcinoma (pCCA), depending on tumor location and vascular involvement. This study compared postoperative mortality and long-term survival of right- versus left-sided liver resections for pCCA. METHODS Patients who underwent major liver resection for pCCA at 25 Western centers were stratified according to the type of hepatectomy-left, extended left, right, and extended right. The primary outcomes were 90-day mortality and overall survival (OS). RESULTS Between 2000 and 2022, 1701 patients underwent major liver resection for pCCA. The 90-day mortality was 9% after left-sided and 18% after right-sided liver resection (p < 0.001). The 90-day mortality rates were 8% (44/540) after left, 11% (29/276) after extended left, 17% (51/309) after right, and 19% (108/576) after extended right hepatectomy (p < 0.001). Median OS was 30 months (95% confidence interval [CI] 27-34) after left and 23 months (95% CI 20-25) after right liver resection (p < 0.001), and 33 months (95% CI 28-38), 27 months (95% CI 23-32), 25 months (95% CI 21-30), and 21 months (95% CI 18-24) after left, extended left, right, and extended right hepatectomy, respectively (p < 0.001). A left-sided resection was an independent favorable prognostic factor for both 90-day mortality and OS compared with right-sided resection, with similar results after excluding 90-day fatalities. CONCLUSIONS A left or extended left hepatectomy is associated with a lower 90-day mortality and superior OS compared with an (extended) right hepatectomy for pCCA. When both a left and right liver resection are feasible, a left-sided liver resection is preferred.
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Affiliation(s)
- Pim B Olthof
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands.
- Department of Surgery, University Medical Center, Groningen, Groningen, The Netherlands.
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ruslan Alikhanov
- Department of Liver and Pancreatic Surgery, Department of Transplantation, Moscow Clinical Scientific Centre, Moscow, Russia
| | - Ramón Charco
- Department of HBP Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alfredo Guglielmi
- Division of General Surgery, Department of Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School, Verona, Italy
| | - Jeroen Hagendoorn
- Department of Surgical Oncology, University Medical Centre/Utrecht University, Utrecht, The Netherlands
| | - Abdul Hakeem
- Division of Surgery, Department of Hepatobiliary and Liver Transplant Surgery, St James's University Hospital, Leeds, UK
| | | | - William R Jarnagin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Hauke Lang
- Department of General, Visceral and Transplantation Surgery, University Medical Center, Mainz, Germany
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Massimo Malago
- Department of HPB and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK
| | | | - Silvio Nadalin
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Ulf Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-KlinikumCharité-Universitätsmedizin Berlin, Berlin, Germany
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Ravaioli
- General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Keith J Roberts
- Department of Surgery, University Hospital Birmingham, Birmingham, UK
| | - Erik Schadde
- Department of Surgery, Rush University Medical Center Chicago, Chicago, IL, USA
| | - Andreas A Schnitzbauer
- Universitätsklinikum Frankfurt, Klinik für AllgemeinViszeral und Transplantationschirurgie, Frankfurt, Germany
| | - Ernesto Sparrelid
- Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Baki Topal
- Department of Surgery, Catholic University of Leuven, Leuven, Belgium
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of HBP, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Hospital, Naples, Italy
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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6
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Ratti F, Marino R, Olthof PB, Pratschke J, Erdmann JI, Neumann UP, Prasad R, Jarnagin WR, Schnitzbauer AA, Cescon M, Guglielmi A, Lang H, Nadalin S, Topal B, Maithel SK, Hoogwater FJH, Alikhanov R, Troisi R, Sparrelid E, Roberts KJ, Malagò M, Hagendoorn J, Malik HZ, Olde Damink SWM, Kazemier G, Schadde E, Charco R, de Reuver PR, Groot Koerkamp B, Aldrighetti L. Predicting futility of upfront surgery in perihilar cholangiocarcinoma: Machine learning analytics model to optimize treatment allocation. Hepatology 2024; 79:341-354. [PMID: 37530544 DOI: 10.1097/hep.0000000000000554] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/21/2023] [Accepted: 06/27/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND While resection remains the only curative option for perihilar cholangiocarcinoma, it is well known that such surgery is associated with a high risk of morbidity and mortality. Nevertheless, beyond facing life-threatening complications, patients may also develop early disease recurrence, defining a "futile" outcome in perihilar cholangiocarcinoma surgery. The aim of this study is to predict the high-risk category (futile group) where surgical benefits are reversed and alternative treatments may be considered. METHODS The study cohort included prospectively maintained data from 27 Western tertiary referral centers: the population was divided into a development and a validation cohort. The Framingham Heart Study methodology was used to develop a preoperative scoring system predicting the "futile" outcome. RESULTS A total of 2271 cases were analyzed: among them, 309 were classified within the "futile group" (13.6%). American Society of Anesthesiology (ASA) score ≥ 3 (OR 1.60; p = 0.005), bilirubin at diagnosis ≥50 mmol/L (OR 1.50; p = 0.025), Ca 19-9 ≥ 100 U/mL (OR 1.73; p = 0.013), preoperative cholangitis (OR 1.75; p = 0.002), portal vein involvement (OR 1.61; p = 0.020), tumor diameter ≥3 cm (OR 1.76; p < 0.001), and left-sided resection (OR 2.00; p < 0.001) were identified as independent predictors of futility. The point system developed, defined three (ie, low, intermediate, and high) risk classes, which showed good accuracy (AUC 0.755) when tested on the validation cohort. CONCLUSIONS The possibility to accurately estimate, through a point system, the risk of severe postoperative morbidity and early recurrence, could be helpful in defining the best management strategy (surgery vs. nonsurgical treatments) according to preoperative features.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milano, Italy
| | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milano, Italy
| | - Pim B Olthof
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Johann Pratschke
- Department of Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Joris I Erdmann
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Ulf P Neumann
- Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raj Prasad
- Department of Hepatobiliary and Liver Transplant Surgery, Division of Surgery, St James's University Hospital, Leeds, United Kingdom
| | - William R Jarnagin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andreas A Schnitzbauer
- Department of General and Visceral Surgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Matteo Cescon
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alfredo Guglielmi
- Unit of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Hospital Mainz, Mainz, Germany
| | - Silvio Nadalin
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Baki Topal
- Department of Abdominal Surgery, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Frederik J H Hoogwater
- Department of Surgery, Section of Hepatobiliary Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruslan Alikhanov
- Department of Liver and Pancreatic Surgery, Moscow Clinical Scientific Center, Russia
| | - Roberto Troisi
- Department of Clinical Medicine and Surgery, Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Federico II University Hospital, Naples, Italy
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Keith J Roberts
- Department of Surgery, University Hospital Birmingham, Birmingham, United Kingdom
| | - Massimo Malagò
- Department of HPB- and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, United Kingdom
| | - Jeroen Hagendoorn
- Department of Surgery, Regional Academic Cancer Centre Utrecht, St Antonius Hospital, Nieuwegein and University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hassan Z Malik
- Department of Hepatobiliary Surgery, Aintree University Hospital, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, United Kingdom
| | - Steven W M Olde Damink
- Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Erik Schadde
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Ramon Charco
- Department of HBP Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Spain
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milano, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
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7
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Schläpfer M, Schadde E, Braun J, Soll C, Breitenstein S, Weber M, Gutknecht S, Ganter MT, Filipovic M, Beck-Schimmer B. Effect of volatile versus total intravenous anaesthesia on circulating tumour cells after pancreatic adenocarcinoma resection: multicentre randomized clinical trial. Br J Surg 2024; 111:znad357. [PMID: 37963143 PMCID: PMC10771133 DOI: 10.1093/bjs/znad357] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/08/2023] [Accepted: 06/13/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Martin Schläpfer
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Erik Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of Surgery, Rush University Medical Centre, Chicago, Illinois, USA
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Julia Braun
- Departments of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christopher Soll
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Markus Weber
- Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland
| | - Stefan Gutknecht
- Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland
| | - Michael T Ganter
- Institute of Anaesthesiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Miodrag Filipovic
- Department for Anaesthesiology, Intensive, Rescue and Pain Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Beatrice Beck-Schimmer
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
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Görgec B, Benedetti Cacciaguerra A, Pawlik TM, Aldrighetti LA, Alseidi AA, Cillo U, Kokudo N, Geller DA, Wakabayashi G, Asbun HJ, Besselink MG, Cherqui D, Cheung TT, Clavien PA, Conrad C, D’Hondt M, Dagher I, Dervenis C, Devar J, Dixon E, Edwin B, Efanov M, Ettore GM, Ferrero A, Fondevilla C, Fuks D, Giuliante F, Han HS, Honda G, Imventarza O, Kooby DA, Lodge P, Lopez-Ben S, Machado MA, Marques HP, O’Rourke N, Pekolj J, Pinna AD, Portolani N, Primrose J, Rotellar F, Ruzzenente A, Schadde E, Siriwardena AK, Smadi S, Soubrane O, Tanabe KK, Teh CS, Torzilli G, Van Gulik TM, Vivarelli M, Wigmore SJ, Abu Hilal M. An International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery (TOLS). Ann Surg 2023; 277:821-828. [PMID: 35946822 PMCID: PMC10082050 DOI: 10.1097/sla.0000000000005668] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To reach global expert consensus on the definition of TOLS in minimally invasive and open liver resection among renowned international expert liver surgeons using a modified Delphi method. BACKGROUND Textbook outcome is a novel composite measure combining the most desirable postoperative outcomes into one single measure and representing the ideal postoperative course. Despite a recently developed international definition of Textbook Outcome in Liver Surgery (TOLS), a standardized and expert consensus-based definition is lacking. METHODS This international, consensus-based, qualitative study used a Delphi process to achieve consensus on the definition of TOLS. The survey comprised 6 surgical domains with a total of 26 questions on individual surgical outcome variables. The process included 4 rounds of online questionnaires. Consensus was achieved when a threshold of at least 80% agreement was reached. The results from the Delphi rounds were used to establish an international definition of TOLS. RESULTS In total, 44 expert liver surgeons from 22 countries and all 3 major international hepato-pancreato-biliary associations completed round 1. Forty-two (96%), 41 (98%), and 41 (98%) of the experts participated in round 2, 3, and 4, respectively. The TOLS definition derived from the consensus process included the absence of intraoperative grade ≥2 incidents, postoperative bile leakage grade B/C, postoperative liver failure grade B/C, 90-day major postoperative complications, 90-day readmission due to surgery-related major complications, 90-day/in-hospital mortality, and the presence of R0 resection margin. CONCLUSIONS This is the first study providing an international expert consensus-based definition of TOLS for minimally invasive and open liver resections by the use of a formal Delphi consensus approach. TOLS may be useful in assessing patient-level hospital performance and carrying out international comparisons between centers with different clinical practices to further improve patient outcomes.
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Affiliation(s)
- Burak Görgec
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
- Department of Surgery, AmsterdamUMC, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrea Benedetti Cacciaguerra
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Timothy M. Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | | | - Adnan A. Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova, Italy
| | - Norihiro Kokudo
- Department of Surgery, Hepatobiliary Pancreatic Surgery Division, National Center for Global Health and Medicine, Tokyo, Japan
| | - David A. Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Horacio J. Asbun
- Hepato-Biliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL
| | - Marc G. Besselink
- Department of Surgery, AmsterdamUMC, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Paul Brousse University Hospital, Villejuif, France
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Pierre-Alain Clavien
- Department of surgery and transplantation, University Hospital Zurich, Switzerland
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, Clamart, France
| | - Christos Dervenis
- Department of Surgery, Konstantopouleio General Hospital, Nea Ionia, Athens, Greece
| | - John Devar
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Hepato-Pancreatico-Biliary Unit, Department of General Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Elijah Dixon
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Bjørn Edwin
- Department of Hepato-Pancreato-Biliary Surgery and The Intervention Center, Oslo University Hospital Oslo, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Research Centre, Moscow, Russia
| | - Giuseppe M. Ettore
- General Surgery and Transplantation Unit, San Camillo Hospital, Rome, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | | | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Felice Giuliante
- Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Goro Honda
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Oscar Imventarza
- Department of surgery, Hospital Argerich, Buenos Aires, Argentina
- Department of surgery, Hospital Garrahan, Buenos Aires, Argentina
| | - David A. Kooby
- Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Peter Lodge
- HPB and Transplant Unit, St James’s University Hospital, Leeds, UK
| | - Santiago Lopez-Ben
- Department of General and Digestive Surgery, HPB Unit, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | | | - Hugo P. Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Nick O’Rourke
- Department of HPB Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Juan Pekolj
- Division of HPB Surgery and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Antonio D. Pinna
- Abdominal Transplant and HPB Center, Cleveland Clinic Florida, Weston, Florida
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Italy
| | - John Primrose
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fernando Rotellar
- Department of General and Digestive Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Erik Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
- Division of Transplant Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Ajith K. Siriwardena
- Hepatobiliary and Pancreatic Surgery Unit, Manchester University NHS FT, Manchester, UK
| | - Sameer Smadi
- Department of Surgery, King Hussein Medical Center, Amman, Jordan
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France
| | - Kenneth K. Tanabe
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Catherine S.C. Teh
- Section of Hepatobiliary Pancreatic Surgery, Surgical Oncology, and Minimally Invasive Surgery, St Luke’s Medical Center, Quezon City, Philippines
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, Rozzano, Italy
| | - Thomas M. Van Gulik
- Department of Surgery, AmsterdamUMC, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Stephen J. Wigmore
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, UK
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Olthof PB, Buettner S, Schadde E. The relevance of the liver volume increase after ALPPS. Liver Int 2022; 42:2907. [PMID: 35912935 DOI: 10.1111/liv.15376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Pim B Olthof
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Stefan Buettner
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Erik Schadde
- Division of Transplant Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Chirurgisches Zentrum Zurich, Klinik Hirslanden, Zurich, Switzerland.,Chirurgie Zentrum Zentralschweiz, Hirslanden Klinik, St Anna Luzern, Luzern, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland
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10
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Korenblik R, van Zon JFJA, Olij B, Heil J, Dewulf MJL, Neumann UP, Olde Damink SWM, Binkert CA, Schadde E, van der Leij C, van Dam RM, van Baardewijk LJ, Barbier L, Binkert CA, Billingsley K, Björnsson B, Andorrà EC, Arslan B, Baclija I, Bemelmans MHA, Bent C, de Boer MT, Bokkers RPH, de Boo DW, Breen D, Breitenstein S, Bruners P, Cappelli A, Carling U, Robert MCI, Chan B, De Cobelli F, Choi J, Crawford M, Croagh D, van Dam RM, Deprez F, Detry O, Dewulf MJL, Díaz-Nieto R, Dili A, Erdmann JI, Font JC, Davis R, Delle M, Fernando R, Fisher O, Fouraschen SMG, Fretland ÅA, Fundora Y, Gelabert A, Gerard L, Gobardhan P, Gómez F, Guiliante F, Grünberger T, Grochola LF, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess G, Hilal MA, Hoffmann M, Iezzi R, Imani F, Inmutto N, James S, Borobia FJG, Jovine E, Kalil J, Kingham P, Kollmar O, Kleeff J, van der Leij C, Lopez-Ben S, Macdonald A, Meijerink M, Korenblik R, Lapisatepun W, Leclercq WKG, Lindsay R, Lucidi V, Madoff DC, Martel G, Mehrzad H, Menon K, Metrakos P, Modi S, Moelker A, Montanari N, Moragues JS, Navinés-López J, Neumann UP, Nguyen J, Peddu P, Primrose JN, Olde Damink SWM, Qu X, Raptis DA, Ratti F, Ryan S, Ridouani F, Rinkes IHMB, Rogan C, Ronellenfitsch U, Serenari M, Salik A, Sallemi C, Sandström P, Martin ES, Sarría L, Schadde E, Serrablo A, Settmacher U, Smits J, Smits MLJ, Snitzbauer A, Soonawalla Z, Sparrelid E, Spuentrup E, Stavrou GA, Sutcliffe R, Tancredi I, Tasse JC, Teichgräber U, Udupa V, Valenti DA, Vass D, Vogl TJ, Wang X, White S, De Wispelaere JF, Wohlgemuth WA, Yu D, Zijlstra IJAJ. Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis. BJS Open 2022; 6:6844022. [PMID: 36437731 PMCID: PMC9702575 DOI: 10.1093/bjsopen/zrac141] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase. RESULTS Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients). CONCLUSION Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
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Affiliation(s)
- Remon Korenblik
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
| | - Jasper F J A van Zon
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bram Olij
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,GROW—Department of Surgery, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Heil
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maxime J L Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ulf P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany,NUTRIM—Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Christoph A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Erik Schadde
- Department of General, Visceral and Transplant Surgery, Klinik Hirslanden, Zurich, Switzerland,Department of General, Visceral and Transplant Surgery, Hirslanden Klink St. Anna Luzern, Luzern, Switzerland
| | | | - Ronald M van Dam
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
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Heil J, Schiesser M, Schadde E. Current trends in regenerative liver surgery: Novel clinical strategies and experimental approaches. Front Surg 2022; 9:903825. [PMID: 36157407 PMCID: PMC9491020 DOI: 10.3389/fsurg.2022.903825] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Liver resections are performed to cure patients with hepatobiliary malignancies and metastases to the liver. However, only a small proportion of patients is resectable, largely because only up to 70% of liver tissue is expendable in a resection. If larger resections are performed, there is a risk of post-hepatectomy liver failure. Regenerative liver surgery addresses this limitation by increasing the future liver remnant to an appropriate size before resection. Since the 1980s, this surgery has evolved from portal vein embolization (PVE) to a multiplicity of methods. This review presents an overview of the available methods and their advantages and disadvantages. The first use of PVE was in patients with large hepatocellular carcinomas. The increase in liver volume induced by PVE equals that of portal vein ligation, but both result only in a moderate volume increase. While awaiting sufficient liver growth, 20%–40% of patients fail to achieve resection, mostly due to the progression of disease. The MD Anderson Cancer Centre group improved the PVE methodology by adding segment 4 embolization (“high-quality PVE”) and demonstrated that oncological results were better than non-surgical approaches in this previously unresectable patient population. In 2012, a novel method of liver regeneration was proposed and called Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS). ALPPS accelerated liver regeneration by a factor of 2–3 and increased the resection rate to 95%–100%. However, ALPPS fell short of expectations due to a high mortality rate and a limited utility only in highly selected patients. Accelerated liver regeneration, however, was there to stay. This is evident in the multiplicity of ALPPS modifications like radiofrequency or partial ALPPS. Overall, rapid liver regeneration allowed an expansion of resectability with increased perioperative risk. But, a standardized low-risk approach to rapid hypertrophy has been missing and the techniques used and in use depend on local expertise and preference. Recently, however, simultaneous portal and hepatic vein embolization (PVE/HVE) appears to offer both rapid hypertrophy and no increased clinical risk. While prospective randomized comparisons are underway, PVE/HVE has the potential to become the future gold standard.
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Affiliation(s)
- Jan Heil
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Marc Schiesser
- Chirurgisches Zentrum Zürich (CZZ), Klinik Hirslanden Zurich, Zurich, Switzerland
- Chirurgie Zentrum Zentralschweiz (CZZ), Hirslanden St. Anna, Lucerne, Switzerland
| | - Erik Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Chirurgisches Zentrum Zürich (CZZ), Klinik Hirslanden Zurich, Zurich, Switzerland
- Chirurgie Zentrum Zentralschweiz (CZZ), Hirslanden St. Anna, Lucerne, Switzerland
- Department of Surgery, Rush University Medical Center Chicago, Chicago, IL, United States
- Correspondence: Erik Schadde
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Korenblik R, Olij B, Aldrighetti LA, Hilal MA, Ahle M, Arslan B, van Baardewijk LJ, Baclija I, Bent C, Bertrand CL, Björnsson B, de Boer MT, de Boer SW, Bokkers RPH, Rinkes IHMB, Breitenstein S, Bruijnen RCG, Bruners P, Büchler MW, Camacho JC, Cappelli A, Carling U, Chan BKY, Chang DH, Choi J, Font JC, Crawford M, Croagh D, Cugat E, Davis R, De Boo DW, De Cobelli F, De Wispelaere JF, van Delden OM, Delle M, Detry O, Díaz-Nieto R, Dili A, Erdmann JI, Fisher O, Fondevila C, Fretland Å, Borobia FG, Gelabert A, Gérard L, Giuliante F, Gobardhan PD, Gómez F, Grünberger T, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess GF, Hoffmann MH, Iezzi R, Imani F, Nguyen J, Jovine E, Kalff JC, Kazemier G, Kingham TP, Kleeff J, Kollmar O, Leclercq WKG, Ben SL, Lucidi V, MacDonald A, Madoff DC, Manekeller S, Martel G, Mehrabi A, Mehrzad H, Meijerink MR, Menon K, Metrakos P, Meyer C, Moelker A, Modi S, Montanari N, Navines J, Neumann UP, Peddu P, Primrose JN, Qu X, Raptis D, Ratti F, Ridouani F, Rogan C, Ronellenfitsch U, Ryan S, Sallemi C, Moragues JS, Sandström P, Sarriá L, Schnitzbauer A, Serenari M, Serrablo A, Smits MLJ, Sparrelid E, Spüntrup E, Stavrou GA, Sutcliffe RP, Tancredi I, Tasse JC, Udupa V, Valenti D, Fundora Y, Vogl TJ, Wang X, White SA, Wohlgemuth WA, Yu D, Zijlstra IAJ, Binkert CA, Bemelmans MHA, van der Leij C, Schadde E, van Dam RM. Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy. Cardiovasc Intervent Radiol 2022; 45:1391-1398. [PMID: 35790566 PMCID: PMC9458562 DOI: 10.1007/s00270-022-03176-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022]
Abstract
STUDY PURPOSE The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases. METHODS The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection. RESULTS Not applicable. CONCLUSION DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR. TRIAL REGISTRATION Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).
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Affiliation(s)
- R Korenblik
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - B Olij
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - M Abu Hilal
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - M Ahle
- Deparment of Radiology, University Hospital, Linköping, Sweden
| | - B Arslan
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - L J van Baardewijk
- Department of Radiology, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - I Baclija
- Department of Radiology, Clinic Favoriten, Vienna, Austria
| | - C Bent
- Department of Radiology, Bournemouth and Christuchurch, The Royal Bournemouth and Christchurch Hospitals, Bournemouth and Christuchurch, UK
| | - C L Bertrand
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - B Björnsson
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - M T de Boer
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - S W de Boer
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R P H Bokkers
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Breitenstein
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - R C G Bruijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Bruners
- Department of Radiology, University Hospital Aachen, Aachen, Germany
| | - M W Büchler
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - J C Camacho
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - U Carling
- Department of Radiology, University Hospital Oslo, Oslo, Norway
| | - B K Y Chan
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - D H Chang
- Department of Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Choi
- Department of Surgery, Western Health Footscray, Footscray, Australia
| | - J Codina Font
- Department of Radiology, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - M Crawford
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - D Croagh
- Department of Surgery, Monash Health, Clayton, Australia
| | - E Cugat
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - R Davis
- Department of Radiology, Aintree University Hospitals NHS, Liverpool, UK
| | - D W De Boo
- Department of Radiology, Monash Health, Clayton, Australia
| | - F De Cobelli
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
| | | | - O M van Delden
- Department of Radiology, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - M Delle
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - O Detry
- Department of Surgery, CHU de Liège, Liège, Belgium
| | - R Díaz-Nieto
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - A Dili
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - J I Erdmann
- Department of Surgery, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - O Fisher
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - C Fondevila
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Å Fretland
- Department of Surgery, University Hospital Oslo, Oslo, Norway
| | - F Garcia Borobia
- Department of Surgery, Hospital Parc Taulí de Sabadell, Sabadell, Spain
| | - A Gelabert
- Department of Radiology, Hospital Parc Taulí de Sabadell, Sabadell, Spain
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - L Gérard
- Department of Radiology, CHU de Liège, Liège, Belgium
| | - F Giuliante
- Department of Surgery, Gemelli University Hospital Rome, Rome, Italy
| | - P D Gobardhan
- Department of Surgery, Amphia, Breda, The Netherlands
| | - F Gómez
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T Grünberger
- Department of Surgery, HPB Center Vienna Health Network, Clinic Favoriten, Vienna, Austria
| | - D J Grünhagen
- Department of Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - J Guitart
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - J Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Heil
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - D Heise
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - E Herrero
- Department of Surgery, University Hospital Mútua Terassa, Terassa, Spain
| | - G F Hess
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - M H Hoffmann
- Department of Radiology, St. Clara Spital, Basel, Switzerland
| | - R Iezzi
- Department of Radiology, Gemelli University Hospital, Rome, Italy
| | - F Imani
- Department of Radiology, Amphia, Breda, The Netherlands
| | - J Nguyen
- Department of Radiology, Western Health Footscray, Footscray, Australia
| | - E Jovine
- Department of Surgery, Ospedale Maggiore di Bologna, Bologna, Italy
| | - J C Kalff
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Kazemier
- Department of Surgery, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - T P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Kleeff
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - O Kollmar
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - W K G Leclercq
- Department of Surgery, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - S Lopez Ben
- Department of Surgery, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - V Lucidi
- Department of Surgery, Hôpital Erasme, Brussels, Belgium
| | - A MacDonald
- Department of Radiology, Oxford University Hospital NHS, Oxford, UK
| | - D C Madoff
- Department of Radiology, Yale School of Medicine, New Haven, USA
| | - S Manekeller
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Martel
- Department of Surgery, The Ottawa Hospital, Ottawa, Canada
| | - A Mehrabi
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - H Mehrzad
- Department of Radiology, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - M R Meijerink
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - K Menon
- Department of Surgery, King's College Hospital NHS, London, UK
| | - P Metrakos
- Department of Surgery, McGill University Health Centre, Montréal, Canada
| | - C Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - A Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - S Modi
- Department of Radiology, University Hospital Southampton NHS, Southampton, UK
| | - N Montanari
- Department of Radiology, Ospedale Maggiore Di Bologna, Bologna, Italy
| | - J Navines
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - U P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - P Peddu
- Department of Radiology, King's College Hospital NHS, London, UK
| | - J N Primrose
- Department of Surgery, University Hospital Southampton NHS, Southampton, UK
| | - X Qu
- Department of Radiology, Zhongshan Hospital, Fundan University, Shanghai, China
| | - D Raptis
- Department of Surgery, Royal Free Hospital NHS, London, UK
| | - F Ratti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - F Ridouani
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C Rogan
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - U Ronellenfitsch
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - S Ryan
- Department of Radiology, The Ottawa Hospital, Ottawa, Canada
| | - C Sallemi
- Department of Radiology, Fondazione Poliambulanza, Brescia, Italy
| | - J Sampere Moragues
- Department of Radiology, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - P Sandström
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - L Sarriá
- Department of Radiology, University Hospital Miguel Servet, Saragossa, Spain
| | - A Schnitzbauer
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - M Serenari
- Department of Surgery, General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Serrablo
- Department of Surgery, University Hospital Miguel Servet, Saragossa, Spain
| | - M L J Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Sparrelid
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E Spüntrup
- Department of Radiology, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - G A Stavrou
- Department of Surgery, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - R P Sutcliffe
- Department of Surgery, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - I Tancredi
- Department of Radiology, Hôpital Erasme, Brussels, Belgium
| | - J C Tasse
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - V Udupa
- Department of Surgery, Oxford University Hospital NHS, Oxford, UK
| | - D Valenti
- Department of Radiology, McGill University Health Centre, Montréal, Canada
| | - Y Fundora
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T J Vogl
- Department of Radiology, University Hosptital Frankfurt, Frankfurt, Germany
| | - X Wang
- Department of Surgery, Zhongshan Hospital, Fundan University, Shanghai, China
| | - S A White
- Department of Surgery, Newcastle Upon Tyne Hospitals NHS, Newcastle upon Tyne, UK
| | - W A Wohlgemuth
- Department of Radiology, University Hospital Halle (Saale), Halle, Germany
| | - D Yu
- Department of Radiology, Royal Free Hospital NHS, London, UK
| | - I A J Zijlstra
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - C A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - M H A Bemelmans
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - C van der Leij
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Schadde
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Department of Surgery, Rush University Medical Center Chicago, Chicago, USA
| | - R M van Dam
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany.
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Kent P, Schadde E, Fisher OM, Cornelius A, Estberg E, Ellison J, Kim T, Tasse JC. Nivolumab and lenvatanib combination for fibrolamellar carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4111 Background: Fibrolamellar Carcinoma (FLC) is a rare form of primary liver cancer affecting children and young adults that often presents at an advanced stage and even with surgery has an 80% relapse rate. Unresectable FLC patients are considered incurable and have short life expectancy. Effective neoadjuvant and adjuvant systemic therapies are needed to increase chances at remission and protect against relapse. Because of success as single agents in HCC, we tried the combination of nivolumab (NIV) and lenvatanib (LEN) in FLC patients who had exhausted more common therapies. Our objective is to describe our experience using combination NIV-LEN in FLC patients. Methods: Over the last 5 years we have seen over 90 patients with FLC at our institution. After securing IRB approval, (ORA Number: 19071603-IRB01), we collected data in a de-identified fashion for all patients who had received NIV-LEN. Results: Twenty patients (6M/14F), median age at diagnosis/start of NIV-LEN 17/20 (7-52) have received at total of 349 cycles of NIV-LEN (NIVO 3mg/kg IV q2 weeks) and lenvatanib 8mg po daily, 5 adjuvant, 14 neoadjuvant and one both. All had cross sectional imaging every 3 months with independent review. The median number of cycles/months of follow up was 19.5 (3-43)/13.5 (3-31) respectively. The median number of prior relapses, systemic therapies, prior abdominal surgeries, and prior radiation (IR ablations, TARE, TACE, SBRT) were 3.5 (0-7), 3 (0-11), 2 (0-6), and 2.5 (0-13) respectively. Three patients had gemcitabine added to NIVO-LEN for part ( < 1/3) of their regimen. The best response by RECIST 1.1 of the 14 neoadjuvant patients was 3 CR, 3 PR, 7 SD and 2 PD, for an overall response rate (PR + CR) of 40% and overall control rate (CR + PR + SD) of 87%. Seven of 20 (30%) stopped NIVO-LEN [PD (3), infection (2), or patients’ wishes (2)] while 14 (70%) continue, including all adjuvant patients who remain in CR (median follow-up of 10 months). The 6-, 12-, and 24-month progression free survival (PFS) and overall survival (OS) were: (70%,49%,49%) and (94%,94%,73%) respectively. For 14 of 17 (82%) relapsed patients, the PFS was longer than the patients’ most recent PFS, and longest ever in 9 (53%). Six of the 14 initial non-surgical candidates (43%) either had surgery (2), or avoided surgery (3 CR, 1 ablation). There were 2 grade 3 toxicities (both infections) and no grade 4 toxicities. The most common toxicities were hypertension and fatigue in 25% and 20% respectively. One patient, after 5 relapses, had more than 120 lung nodules > 1cm that after 14 months of NIVO-LEN achieved CR and has remained in CR for another 14 months. Conclusions: Our retrospective experience with the novel immune-chemotherapy combination of NIV-LEN for FLC in an extremely rare disease with no proven systemic therapies is encouraging, especially for those who are not surgical candidates or in a surgical remission. We hope this report can inform future prospective trials in treating this deadly disease.
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Affiliation(s)
- Paul Kent
- Rush University Medical Center, Chicago, IL
| | | | | | | | | | | | - Thomas Kim
- Rush University Medical Center, Chicago, IL
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14
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Heil J, Heid F, Bechstein WO, Björnsson B, Brismar TB, Carling U, Erdmann J, Fretland ÅA, Grunhagen D, Hana RA, Hohmann J, Linke R, Meyer Y, Nawawi A, Olthof PB, Sandström P, Schnitzbauer AA, Sparrelid E, Verhoef C, Metrakos P, Schadde E. Sarcopenia predicts reduced liver growth and reduced resectability in patients undergoing portal vein embolization before liver resection - A DRAGON collaborative analysis of 306 patients. HPB (Oxford) 2022; 24:413-421. [PMID: 34526229 DOI: 10.1016/j.hpb.2021.08.818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/01/2021] [Revised: 07/06/2021] [Accepted: 08/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND After portal vein embolization (PVE) 30% fail to achieve liver resection. Malnutrition is a modifiable risk factor and can be assessed by radiological indices. This study investigates, if sarcopenia affects resectability and kinetic growth rate (KGR) after PVE. METHODS A retrospective study was performed of the outcome of PVE at 8 centres of the DRAGON collaborative from 2010 to 2019. All malignant tumour types were included. Sarcopenia was defined using gender, body mass and skeletal muscle index. First imaging after PVE was used for liver volumetry. Primary and secondary endpoints were resectability and KGR. Risk factors impacting liver growth were assessed in a multivariable analysis. RESULTS Eight centres identified 368 patients undergoing PVE. 62 patients (17%) had to be excluded due to unavailability of data. Among the 306 included patients, 112 (37%) were non-sarcopenic and 194 (63%) were sarcopenic. Sarcopenic patients had a 21% lower resectability rate (87% vs. 66%, p < 0.001) and a 23% reduced KGR (p = 0.02) after PVE. In a multivariable model dichotomized for KGR ≥2.3% standardized FLR (sFLR)/week, only sarcopenia and sFLR before embolization correlated with KGR. CONCLUSION In this largest study of risk factors, sarcopenia was associated with reduced resectability and KGR in patients undergoing PVE.
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Affiliation(s)
- Jan Heil
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Main, Germany
| | - Franziska Heid
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Wolf O Bechstein
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Main, Germany
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Torkel B Brismar
- Department of Clinical Science and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Carling
- Department of Radiology Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Joris Erdmann
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Åsmund A Fretland
- Department of Hepato-Pancreatic-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Dirk Grunhagen
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Renato A Hana
- Department of Diagnostic Radiology, McGill General Hospital, Montreal, Canada
| | - Joachim Hohmann
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland
| | - Richard Linke
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Main, Germany
| | - Yannick Meyer
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Abrar Nawawi
- Department of Surgery, McGill Health Center Research Institute, Cancer Program, Montreal, Canada
| | - Pim B Olthof
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Per Sandström
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Andreas A Schnitzbauer
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Main, Germany
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
| | - Cornelis Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Peter Metrakos
- Department of Surgery, McGill Health Center Research Institute, Cancer Program, Montreal, Canada
| | - Erik Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland; Department of Surgery, Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA.
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15
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Williams MD, Thomas J, Paner A, Chan EY, Hollinger EF, Schadde E, Hertl M, Santos CAQ, Olaitan OK. Can Donor-Derived Cell-Free DNA Detect Graft-Versus-Host Disease in Solid Organ Transplantation: A Case Report. Transplant Proc 2021; 54:176-179. [PMID: 34961600 DOI: 10.1016/j.transproceed.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022]
Abstract
Graft-versus-host disease (GVHD) is a rare complication after solid organ transplant. We present a case of GVHD after simultaneous pancreas kidney transplant. The patient was diagnosed with a cutaneous biopsy after developing the classic symptoms of maculopapular rash, diarrhea, and pancytopenia. However, this patient had unexplained elevations in donor-derived cell-free DNA (dd-cfDNA) for months before the onset of GVHD symptoms. We hypothesize that GVHD may be associated with elevated dd-cfDNA as a result of massive donor lymphocyte proliferation and turnover. Further investigation is warranted because earlier diagnosis and treatment could improve outcomes in an otherwise lethal disease.
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Affiliation(s)
- Michael D Williams
- Department of Surgery, Rush University Medical Center, Chicago, Illinois.
| | - Joshua Thomas
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Agne Paner
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Edie Y Chan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Edward F Hollinger
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Erik Schadde
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Martin Hertl
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Carlos A Q Santos
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
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16
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Heid F, Toti J, C Balzarotti Canger R, Cristaudi A, Breitenstein S, Majno-Hurst P, Schadde E. Is laparoscopic major hepatectomy feasible and safe in Swiss cantonal hospitals? Swiss Med Wkly 2021; 151:w30044. [PMID: 34964580 DOI: 10.4414/smw.2021.w30044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The number of laparoscopic liver resections is increasing worldwide, including in Switzerland. However, laparoscopy is mostly used for minor resections. Little is known about indications for and outcomes of major liver resections performed laparoscopically. The aim of this study was to compare the clinical outcome of open and laparoscopic major liver resection cohorts in two Swiss centres. METHODS Patients undergoing open or laparoscopic major hepatectomy (>3 segments) in two cantonal hospitals from January 2015 to December 2019 were analysed. All disease types except perihilar cholangiocarcinomas, rare malignancies and resections with biliary reconstruction were included. The primary outcome was the number of complications incurred. Operation time, blood loss, hospital stay and 90-day mortality were secondary outcomes investigated. A separate analysis was performed for colorectal liver metastases, the most common indication. Potential risk factors for major complications were evaluated in a multivariate analysis. RESULTS A total of 88 patients were identified. Among those, 34 patients underwent laparoscopic major hepatectomy (LAPH) and 54 patients open major hepatectomy (OH). The two groups did not differ in demographics. The most common indication was malignancy (LAPH 94% vs OH 98%), mainly colorectal liver metastases (LAPH 53% vs OH 59%). There was no significant difference in major complications (21% vs 15%, p = 0.565). Median operation time (LAPH 433 minutes, interquartile range [IQR 351-482 vs OH 397 minutes, IQR 296-446; p = 0.222), blood loss (325 ml, IQR 200-575 vs 475 ml, IQR 300-800; p = 0.150) and hospital stay (9 days, IQR 8-14 vs 11 days, IQR 9-14; p = 0.441) were comparable between the two cohorts. There was no significant difference in 90-day mortality (3% vs 7%, p = 0.881). The laparoscopic technique was not identified as a risk factor for major complications in a multivariate analysis. CONCLUSION This first report from Switzerland evaluating outcomes of laparoscopic major hepatectomies showed no difference in complications and clinical non-inferiority compared with open major hepatectomy.
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Affiliation(s)
- Franziska Heid
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Switzerland
| | - Johannes Toti
- Department of General and Visceral Surgery, Cantonal Hospital Lugano, Switzerland
| | | | - Alessandra Cristaudi
- Department of General and Visceral Surgery, Cantonal Hospital Lugano, Switzerland
| | - Stefan Breitenstein
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Switzerland
| | - Pietro Majno-Hurst
- Department of General and Visceral Surgery, Cantonal Hospital Lugano, Switzerland
| | - Erik Schadde
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Switzerland.,Institute of Physiology, University of Zurich, Switzerland.,Department of Surgery, Rush University Medical Center Chicago, USA
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17
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Stavrou GA, Stang A, Raptis DA, Schadde E, Zeile M, Brüning R, Wagner KC, Huber TM, Oldhafer KJ. Intraoperative (Contrast-Enhanced) Ultrasound Has the Highest Diagnostic Accuracy of Any Imaging Modality in Resection of Colorectal Liver Metastases. J Gastrointest Surg 2021; 25:3160-3169. [PMID: 34159555 DOI: 10.1007/s11605-021-04925-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
AIM Defining sensitivity, specificity, diagnostic accuracy for detection of colorectal liver metastases in imaging compared to intraoperative assessment. Defining a cutoff, where accuracy of detection is impaired. METHODS Prospective single-institution clinical trial (clinicaltrials.gov: NCT01522209). Patients underwent CEUS, MDCT, and 3 Tesla EOB-MRI within 2 weeks preoperatively. Intraoperative palpation, IOUS, and CEIOUS were performed. A patient and lesion-based database was analyzed for accuracy of detection of CEUS, CT, MRI, and Palp/IOUS/CEIOUS combined read. Histology was standard of reference. RESULTS Forty-seven high tumor load (mean 5, 4 lesions) patients were analyzed. Histopathology confirmed 264 lesions (245 malignant: 19 benign). Accuracy for detection of all lesions: CEUS 63%, CT 71%, MRI 92%, and PALP/IOUS/CEIOUS 98%. ROC analysis for lesion size showed severe impairment of accuracy in lesion detection smaller than 5mm. Intraoperative imaging was not impaired by lesion size. Patient-based analysis revealed a change of resection plan after IOUS/CEIOUS in 35% of patients. CONCLUSION At 5-mm lesion size, preoperative imaging shows a drop in accuracy of detection. In patients with multiple lesions, addition of MRI to MDCT seems useful. Accuracy of intraoperative ultrasound is not impacted by lesion size and should be mandatory. CEIOUS can improve intraoperative decision-making. TRIAL REGISTRATION Study registered with clinicaltrials.gov : NCT01522209.
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Affiliation(s)
- Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken General Hospital, Saarbruecken, Germany. .,Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.
| | - Axel Stang
- Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.,Department of Medical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Dimitri A Raptis
- Department of Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Erik Schadde
- Department of Surgery, Division of Surgical Oncology and Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA.,Institute of Physiology, University of Zürich Campus Irchel, Zürich, Switzerland.,Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Martin Zeile
- Department of Radiology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Roland Brüning
- Department of Radiology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Kim C Wagner
- Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Tessa M Huber
- Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Karl J Oldhafer
- Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.,Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
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18
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Lalazar G, Requena D, Ramos-Espiritu L, Ng D, Bhola PD, de Jong YP, Wang R, Narayan NJC, Shebl B, Levin S, Michailidis E, Kabbani M, Vercauteren KOA, Hurley AM, Farber BA, Hammond WJ, Saltsman JA, Weinberg EM, Glickman JF, Lyons BA, Ellison J, Schadde E, Hertl M, Leiting JL, Truty MJ, Smoot RL, Tierney F, Kato T, Wendel HG, LaQuaglia MP, Rice CM, Letai A, Coffino P, Torbenson MS, Ortiz MV, Simon SM. Identification of Novel Therapeutic Targets for Fibrolamellar Carcinoma Using Patient Derived Xenografts and Direct from Patient Screening. Cancer Discov 2021; 11:2544-2563. [PMID: 34127480 DOI: 10.1158/2159-8290.cd-20-0872] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 03/12/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
To repurpose therapeutics for fibrolamellar carcinoma (FLC) we developed and validated patient-derived xenografts (PDX) from surgical resections. Most agents used clinically, and inhibitors of oncogenes overexpressed in FLC showed little efficacy on PDX. A high-throughput functional drug screen found primary and metastatic FLC were vulnerable to clinically available inhibitors of TOPO1 and HDAC, and to napabucasin. Napabucasin's efficacy was mediated through reactive oxygen species and inhibition of translation initiation, and specific inhibition of eIF4A was effective. The sensitivity of each PDX line inversely correlated with expression of the anti-apoptotic protein Bcl-xL, and inhibition of Bcl-xL synergized with other drugs. Screening directly on cells dissociated from patient resections validated these results. This demonstrates that a direct functional screen on patient tumors provides therapeutically informative data within a clinically useful time frame. Identifying these novel therapeutic targets and combination therapies is an urgent need, as effective therapeutics for FLC are currently unavailable.
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Affiliation(s)
- Gadi Lalazar
- Laboratory of Cellular Biophysics, Rockefeller University
| | | | | | - Denise Ng
- Cellular Biophysics, Rockefeller University
| | - Patrick D Bhola
- Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Ype P de Jong
- Gastroenterology and Hepatology, Rockefeller University
| | - Ruisi Wang
- Cellular Biophysics, Rockefeller University
| | | | | | | | | | | | | | | | | | | | | | - Ethan M Weinberg
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania
| | - J Fraser Glickman
- High Throughput and Spectroscopy Resource Center, Rockefeller University
| | - Barbara A Lyons
- Department of Chemistry and Biochemistry, New Mexico State University
| | | | - Erik Schadde
- Department of Surgery, Division of Transplantation and Division of Surgical Oncology, Rush University Medical Center
| | - Martin Hertl
- Division of Transplantation, Rush University Medical Center
| | | | - Mark J Truty
- Surgical Oncology, The University of Texas MD Anderson Cancer Center
| | | | - Faith Tierney
- Division of Abdominal Organ Transplantation, NewYork–Presbyterian Hospital
| | - Tomoaki Kato
- Division of Abdominal Organ Transplantation, New York Presbyterian
| | - Hans-Guido Wendel
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center
| | | | - Charles M Rice
- Laboratory of Virology and Infectious Disease, Rockefeller University
| | - Anthony Letai
- Department of Medical Oncology, Dana-Farber Cancer Institute
| | | | | | - Michael V Ortiz
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center
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19
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Najafi A, Schadde E, Binkert CA. Combined simultaneous embolization of the portal vein and hepatic vein (double vein embolization) - a technical note about embolization sequence. CVIR Endovasc 2021; 4:43. [PMID: 34037882 PMCID: PMC8155155 DOI: 10.1186/s42155-021-00230-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Simultaneous portal vein embolization (PVE) and hepatic vein embolization (HVE) has been shown to be feasible, safe and lead to a faster growth of future liver remnant (FLR) than PVE alone. The objective of this study is to highlight different technical aspects as well as importance of embolization order. Materials and methods Seven patients were treated with simultaneous PVE and HVE. In three cases, HVE was performed first followed by PVE and in four cases the other way around. Portal vein branches were embolized using Glubran-Lipiodol mixture in all cases. Hepatic veins were embolized using Amplatzer II plugs sized 8–20 mm. Specific consideration was given to depth of glue penetration in the portal vein defined by visible branch order on the treated side. Results Six of seven patients were discharged home the same day. One patient with infected tumor necrosis died of liver failure 40 days later, otherwise there were no periprocedural clinical complications. Median glue penetration was to the 5th order (4th – 5th) when PVE was performed first and 3rd order (2nd - 4th) when PVE was performed after HVE. In one PVE first case, glue spillage was seen due to marked reduced flow in the right portal vein. There was sufficient FLR growth for subsequent surgical resection in the remaining six patients. Conclusion PVE should be performed prior to HVE because the reduced flow in the portal vein after HVE leads to less deep glue penetration with presumably increased risk of contralateral spillage.
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Affiliation(s)
- Arash Najafi
- Department of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
| | - Erik Schadde
- Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Christoph A Binkert
- Department of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
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20
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Abstract
e16161 Background: Fibrolamellar carcinoma (FLC) is an exceedingly rare liver cancer affecting children and young adults without underlying liver disease. Complete surgical resection is the primary treatment option, but recurrence is common. There are currently no established systemic therapies. We have treated patients in both the neoadjuvant and adjuvant setting with three novel combination therapies: 5-fluorouracil/interferon/nivolumab (“Triple Therapy” or TT), gemcitabine/oxaliplatin/lenvatinib (GOL), and nivolumab/lenvatinib/quercetin (NLQ). The purpose of this study was to evaluate objective responses and tolerability of three multi-agent systemic therapies in the treatment of FLC. Methods: Data from all patients with FLC who received TT, GOL, or NLQ between May 2018 and February 2021 were reviewed. Patients who received a minimum of six cycles of systemic therapy with follow up scans at least two months after initiation were assessed based on objective response, survival, and toxicity. Results: Twenty-nine patients with FLC who were treated with novel multi-agent systemic therapy were evaluable based on the above criteria. Median age at start of treatment was 20 (7-52; 16F, 12M, 1 non-disclosed). Twenty-three patients received one combination therapy (13 TT, 8 GOL, 2 NLQ), five received two different lines (3 TT/NLQ, 2 TT/GOL), and one patient received all three novel combinations. Between our 29 patients, they had relapsed 36 total times, and 11 had already tried 2+ systemic therapies. Best RECIST 1.1 objective response (clinical remission + partial response) and tumor control rate (clinical remission + partial response + stable disease) were 58%/95%, 55%/100%, and 33%/83% for TT, GOL, and NLQ respectively. The median longest Progression Free Survival (PFS) on any novel multi-agent regimen was 9 months (2-29; 9.5 for TT, 7 for GOL, 6.5 for NLQ), with 18 patients still receiving the therapy extending their PFS. Of those with previous relapses, 56% have a PFS longer than their previous longest remission and 69% have a PFS longer than their previous shortest time to relapse. Half of patients with previous relapses are still receiving the treatment responsible for their longest PFS. Fever, chills, and nausea were the most common adverse effects experienced throughout all three regimens. Seven patients experienced 1+ grade 3 adverse event. There were no toxic deaths or organ failure. Two patients died as a result of disease; their longest PFS (1 on GOL, 1 on TT) were nine and 10 months. Conclusions: FLC is a devastating cancer with patients often relapsing even after successful surgical remission. There is a strong need for effective and tolerable systemic therapies for those with unresectable, relapsed, progressive, or metastatic disease. We have had promising results in treating FLC and prolonging survival with minimal toxicities using novel multi-agent regimens.
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Affiliation(s)
| | | | | | - Paul Kent
- Rush University Medical Center, Chicago, IL
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21
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Santos CAQ, Rhee Y, Hollinger EF, Olaitan OK, Schadde E, Peev V, Saltzberg SN, Hertl M. Comparative incidence and outcomes of COVID-19 in kidney or kidney-pancreas transplant recipients versus kidney or kidney-pancreas waitlisted patients: A single-center study. Clin Transplant 2021; 35:e14362. [PMID: 33998716 PMCID: PMC8209946 DOI: 10.1111/ctr.14362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 epidemiologic studies comparing immunosuppressed and immunocompetent patients may provide insight into the impact of immunosuppressants on outcomes. METHODS In this retrospective cohort study, we assembled kidney or kidney-pancreas transplant recipients who underwent transplant from January 1, 2010, to June 30, 2020, and kidney or kidney-pancreas waitlisted patients who were ever on the waitlist from January 1, 2019, to June 30, 2020. We identified laboratory-confirmed COVID-19 until January 31, 2021, and tracked its outcomes by leveraging informatics infrastructure developed for an outcomes research network. RESULTS COVID-19 was identified in 62 of 887 kidney or kidney-pancreas transplant recipients and 20 of 434 kidney or kidney-pancreas waitlisted patients (7.0% vs. 4.6%, p = .092). Of these patients with COVID-19, hospitalization occurred in 48 of 62 transplant recipients and 8 of 20 waitlisted patients (77% vs. 40%, p = .002); intensive care unit admission occurred in 18 of 62 transplant recipients and 2 of 20 waitlisted patients (29% vs. 10%, p = .085); and 7 transplant recipients were mechanically ventilated and died, whereas no waitlisted patients were mechanically ventilated or died (11% vs. 0%, p = .116). CONCLUSIONS Our study provides single-center data and an informatics approach that can be used to inform the design of multicenter studies.
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Affiliation(s)
- Carlos A Q Santos
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Yoona Rhee
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Edward F Hollinger
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Oyedolamu K Olaitan
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Erik Schadde
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vasil Peev
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Samuel N Saltzberg
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Martin Hertl
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
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22
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Heil J, Korenblik R, Heid F, Bechstein WO, Bemelmans M, Binkert C, Björnsson B, Breitenstein S, Detry O, Dili A, Dondelinger RF, Gerard L, Giménez-Maurel T, Guiu B, Heise D, Hertl M, Kalil JA, Klein JJ, Lakoma A, Neumann UP, Olij B, Pappas SG, Sandström P, Schnitzbauer A, Serrablo A, Tasse J, Van der Leij C, Metrakos P, Van Dam R, Schadde E. Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis. Br J Surg 2021; 108:834-842. [PMID: 33661306 DOI: 10.1093/bjs/znaa149] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. METHODS All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis. RESULTS In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. CONCLUSION PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.
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Affiliation(s)
- J Heil
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - R Korenblik
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - F Heid
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - W O Bechstein
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - M Bemelmans
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - C Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - B Björnsson
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - S Breitenstein
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - O Detry
- Department of Abdominal Surgery and Transplantation, University of Liege, Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - A Dili
- Department of Abdominal Surgery, Centre Hospitalier Universitaire Dinant Godinne Saint-Elisabeth - UCL-Namur, Yvoir, Belgium
| | - R F Dondelinger
- Department of Imaging, University Hospital Liege, Liege, Belgium
| | - L Gerard
- Department of Imaging, University Hospital Liege, Liege, Belgium
| | - T Giménez-Maurel
- Department of Surgery, Miguel University Hospital and University of Zaragoza, Zaragoza, Spain
| | - B Guiu
- Department of Radiology, St Eloi University Hospital, Montpellier, France
| | - D Heise
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - M Hertl
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - J A Kalil
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - J J Klein
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - A Lakoma
- Department of Surgery, Section of Hepato-Pancreatico-Biliary Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - U P Neumann
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - B Olij
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - S G Pappas
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - P Sandström
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A Schnitzbauer
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - A Serrablo
- Department of Surgery, Miguel University Hospital and University of Zaragoza, Zaragoza, Spain
| | - J Tasse
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - C Van der Leij
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - P Metrakos
- Department of Surgery, Section of Hepato-Pancreatico-Biliary Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - R Van Dam
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - E Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
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23
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Schadde E, Grunhagen DJ, Verhoef C, Krzywon L, Metrakos P. Limitations in resectability of colorectal liver metastases 2020 - A systematic approach for clinicians and patients. Semin Cancer Biol 2020; 71:10-20. [PMID: 32980499 DOI: 10.1016/j.semcancer.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/12/2020] [Indexed: 12/12/2022]
Abstract
Colorectal liver metastases (CRLM) affect over 50 % of all patients with colorectal cancer, which is the second leading cause of cancer in the western world. Resection of CRLM may provide cure and improves survival over chemotherapy alone. However, resectability of CLRM has to be decided in multidisciplinary tumor boards and is based on oncological factors, technical factors and patient factors. The advances of chemotherapy lead to the abolition of contraindications to resection in favor of technical resectability, but somatic mutations and molecular subtyping may improve selection of patients for resection in the future. Technical factors center around anatomy of the lesions, volume of the remnant liver and quality of the liver parenchymal. Multiple strategies have been developed to overcome volume limitations and they are reviewed here. The least investigated topic is how to select the right patients among an elderly and frail patient population for the large variety of technical options specifically for bi-lobar CRLM to keep 90-day mortality as low as possible. The review is an overview over the current state-of-the art and a systematic guide to the topic of resectability of CRLM for both clinicians and patients.
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Affiliation(s)
- Erik Schadde
- Division of Surgical Oncology and Division of Transplant Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA; Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland.
| | - Dirk J Grunhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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24
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Madoff DC, Odisio BC, Schadde E, Gaba RC, Bennink RJ, van Gulik TM, Guiu B. Improving the Safety of Major Resection for Hepatobiliary Malignancy: Portal Vein Embolization and Recent Innovations in Liver Regeneration Strategies. Curr Oncol Rep 2020; 22:59. [PMID: 32415401 DOI: 10.1007/s11912-020-00922-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW For three decades, portal vein embolization (PVE) has been the "gold-standard" strategy to hypertrophy the anticipated future liver remnant (FLR) in advance of major hepatectomy. During this time, CT volumetry was the most common method to preoperatively assess FLR quality and function and used to determine which patients are appropriate surgical candidates. This review provides the most up-to-date methods for preoperatively assessing the anticipated FLR and summarizes data from the currently available strategies used to induce FLR hypertrophy before surgery for hepatobiliary malignancy. RECENT FINDINGS Functional and physiological imaging is increasingly replacing standard CT volumetry as the method of choice for preoperative FLR assessment. PVE, associating liver partition and portal vein ligation, radiation lobectomy, and liver venous deprivation are all currently available techniques to hypertrophy the FLR. Each strategy has pros and cons based on tumor type, extent of resection, presence or absence of underlying liver disease, age, performance status, complication rates, and other factors. Numerous strategies can lead to FLR hypertrophy and improve the safety of major hepatectomy. Which is best has yet to be determined.
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Affiliation(s)
- David C Madoff
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA.
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik Schadde
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA.,Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland.,Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Ron C Gaba
- Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, IL, USA
| | - Roelof J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital-Montpellier, Montpellier, France
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Schadde E. Combined portal vein and hepatic vein embolization-finally the platinum procedure of regenerative liver surgery? Hepatobiliary Surg Nutr 2020; 9:92-94. [PMID: 32140488 DOI: 10.21037/hbsn.2019.09.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Erik Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,Department of Surgery, Division of Transplant Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
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Tierney JF, Chivukula SV, Poirier J, Pappas SG, Schadde E, Hertl M, Kebebew E, Keutgen X. National Treatment Practice for Adrenocortical Carcinoma: Have They Changed and Have We Made Any Progress? J Clin Endocrinol Metab 2019; 104:5948-5956. [PMID: 31361313 DOI: 10.1210/jc.2019-00915] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 04/18/2019] [Accepted: 07/22/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare malignancy with a dismal prognosis. Two landmark trials published in 2007 and 2012 showed efficacy for adjuvant mitotane in resectable ACC and etoposide/doxorubicin/cisplatin plus mitotane for unresectable ACC, respectively. In this study, we used the National Cancer Database to examine whether treatment patterns and outcomes changed after these trials. METHODS The National Cancer Database was used to examine treatment patterns and survival in patients diagnosed with ACC from 2006 to 2015. Treatment modalities were compared within that group and with a historical cohort (1985 to 2005). χ2 tests were performed, and Cox proportional hazards models were created. RESULTS From 2006 to 2015, 2752 patients were included; 38% of patients (1042) underwent surgery alone, and 31% (859) underwent surgery with adjuvant therapy. Overall 5-year survival rates for all stages after resection were 43% (median, 41 months) in the contemporary cohort and 39% (median, 32 months) in the historical cohort. After 2007, patients who underwent surgery were more likely to receive adjuvant chemotherapy (P = 0.005), and 5-year survival with adjuvant chemotherapy improved (41% vs 25%; P = 0.02). However, survival did not improve in patients with unresectable tumors after 2011 compared with 2006 to 2011 (P = 0.79). Older age, tumor size ≥10 cm, distant metastases, and positive margins were associated with lower survival after resection (hazard ratio range: 1.39 to 3.09; P < 0.03). CONCLUSIONS Since 2007, adjuvant therapy has been used more frequently in patients with resected ACC, and survival for these patients has improved but remains low. More effective systemic therapies for patients with ACC, especially those in advanced stages, are desperately needed.
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Affiliation(s)
- John F Tierney
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Sitaram V Chivukula
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jennifer Poirier
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Sam G Pappas
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Erik Schadde
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, Illinois
- Division of Transplant, Department of Surgery, Rush University Medical Center, Chicago, Illinois
- Cantonal Hospital Winterthur, Department of Surgery, Winterthur, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Martin Hertl
- Division of Transplant, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Electron Kebebew
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California
| | - Xavier Keutgen
- Endocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, The University of Chicago, Chicago, Illinois
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Huiskens J, Schadde E, Lang H, Malago M, Petrowsky H, de Santibañes E, Oldhafer K, van Gulik TM, Olthof PB. Avoiding postoperative mortality after ALPPS-development of a tumor-specific risk score for colorectal liver metastases. HPB (Oxford) 2019; 21:898-905. [PMID: 30611560 DOI: 10.1016/j.hpb.2018.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/07/2018] [Accepted: 11/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND ALPPS is a two-stage hepatectomy that induces more rapid liver growth compared to conventional strategies. This report aims to establish a risk-score to avoid adverse outcomes of ALPPS only for patients with colorectal liver metastases (CRLM) as primary indication for ALPPS. METHODS All patients with CRLM included in the ALPPS registry were included. Risk score analysis was performed for 90-day mortality after ALPPS, defined as death within 90 days after either stage. Two risk scores were generated i.e. one for application before stage-1, and one for application before stage-2. Logistic regression analysis was performed to establish the risk-score. RESULTS In total, 486 patients were included, of which 35 (7%) died 90 days after stage-1 or 2. In the stage-1 risk score, age ≥67 years (OR 3.7), FLR/BW ratio <0.40 (OR 2.9) and total center-volume (OR 2.4) were included. For the stage-2 score age ≥67 years (OR 3.7), FLR/BW ratio <0.40 (OR 2.8), bilirubin 5 days after stage-1 >50 μmol/L (OR 2.4), and stage-1 morbidity grade IIIA or higher (OR 6.3) were included. CONCLUSIONS The CRLM risk-score to predict mortality after ALPPS demonstrates that older patients with small remnant livers in inexperienced centers, especially after experiencing morbidity after stage-1 have adverse outcomes. The risk score may be used to restrict ALPPS to low-risk patient populations.
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Affiliation(s)
- Joost Huiskens
- Department of Experimental Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Erik Schadde
- Department of Surgery, Division of Transplantation, Rush University Medical Center, Chicago, IL, United States; Cantonal Hospital Winterthur, Kanton, Zurich, Switzerland; Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, Universitaetsmedizin Mainz, Mainz, Germany
| | - Massimo Malago
- Department of HPB and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK
| | - Henrik Petrowsky
- Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Karl Oldhafer
- Department of General & Abdominal Surgery, Asklepios Hospital Barmbek, Semmelweis University of Medicine, Germany
| | - Thomas M van Gulik
- Department of Experimental Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Pim B Olthof
- Department of Experimental Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands.
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Olthof PB, van Dam R, Jovine E, Campos RR, de Santibañes E, Oldhafer K, Malago M, Abdalla EK, Schadde E. Accuracy of estimated total liver volume formulas before liver resection. Surgery 2019; 166:247-253. [PMID: 31204072 DOI: 10.1016/j.surg.2019.05.003] [Citation(s) in RCA: 10] [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] [Received: 03/04/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Future remnant liver volume is used to predict the risk for liver failure in patients who will undergo major liver resection. Formulas to estimate total liver volume based on biometric data are widely used to calculate future remnant liver volume; however, it remains unclear which formula is most accurate. This study evaluated published estimate total liver volume formulas to determine which formula best predicts the actual future remnant liver volume based on measurements in a large number of patients who underwent associating liver partition and portal vein ligation for staged hepatectomy surgery. METHODS All patients with complete liver volume data in the associating liver partition and portal vein ligation for staged hepatectomy registry were included in this study. Estimate total liver volume and estimated future remnant liver volume were calculated for 16 published formulas. The median over- or underestimation compared with actual measured volumes were determined for estimate total liver volume and future remnant liver volume. The proportion of patients with an under- or overestimated future remnant liver volume for each formula were compared with each other using a 25% cut-off for each formula. RESULTS Among 529 studied patients, the formulas ranged from a 19% underestimation to a 63% overestimation of estimate total liver volume. Estimation of future remnant liver volume lead to a 10% underestimation to a 5% overestimation among the formulas. Of all studied formulas, the Vauthey1 formula was the most accurate, generating underestimation of future remnant liver volume in 20% and overestimation of future remnant liver volume in 6% of patients. CONCLUSION Validation of 16 published total liver volume formulas in a multicenter international cohort of 529 patients that underwent staged hepatectomy revealed that the Vauthey formula (estimate total liver volume = 18.51 × body weight + 191.8) provides the most accurate prediction of the actual future remnant liver volume.
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Affiliation(s)
- Pim B Olthof
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands; Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ronald van Dam
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands, and Universitätsklinikum Aachen, Aachen, Germany
| | - Elio Jovine
- Department of Surgery, C. A. Pizzardi Maggiore Hospital, Bologna, Italy
| | | | | | - Karl Oldhafer
- Department of General, Visceral and Oncological Surgery, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Massimo Malago
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, UK
| | - Eddie K Abdalla
- Department of Hepato-Pancreato-Biliary Surgery, Northside Hospital Cancer Institute, Atlanta, GA
| | - Erik Schadde
- Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland; Department of Surgery, Rush University Medical Center, Chicago, IL
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Kalil JA, Poirier J, Becker B, Van Dam R, Keutgen X, Schadde E. Laparoscopic Parenchymal-Sparing Hepatectomy: the New Maximally Minimal Invasive Surgery of the Liver-a Systematic Review and Meta-Analysis. J Gastrointest Surg 2019; 23:860-869. [PMID: 30756316 DOI: 10.1007/s11605-019-04128-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Parenchymal-sparing hepatectomies (PSH) are liver resections with preservation of as much liver parenchyma as possible. PSH can be performed laparoscopically (LPSH), but access to the posterosuperior segments is difficult and they are challenging when there are multiple bilobar lesions; the procedure may require repositioning and may be long and cumbersome. The objective of this systematic review is to analyze the feasibility and limitations of laparoscopic PSH in the literature. METHODS A systematic review of the literature was performed by searching Medline/PubMed, Scopus, and Cochrane databases. Resections were categorized by segment(s), and data regarding operative time, blood loss, length of hospital stay, complications, and R0 resection were analyzed. RESULTS Of 351 studies screened for relevance, 48 studies were reviewed. Ten publications fulfilled inclusion criteria, reporting data from 579 patients undergoing LPSH. The most common indication was CRLM (58%) followed by hepatocellular carcinoma (16%). Only 92 patients were reported to have resections of more than one tumor; the maximum number of lesions resected was seven. Of resected lesions, 21.5% were located in the cranial segments. Mean operating time was 335.2 min, estimated blood loss was 462 cc, and hospital stay was 7.6 days. Conversion rate was 9.7%, and complications occurred in 19.4% of cases. No perioperative mortality was reported. R0 resections were achieved in 87.7% of cases. CONCLUSION Laparoscopic PSH is performed and reported, but the data quality is low so far. The main limitation of LPSH is the low number of lesions resected, especially for bilobar, metastatic disease. Prospective reports with tumor-specific oncological data are desirable.
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Affiliation(s)
- Jennifer A Kalil
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653 W. Congress Pkwy, Jelke Building 7th floor, Chicago, IL, 60612, USA
| | - Jennifer Poirier
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653 W. Congress Pkwy, Jelke Building 7th floor, Chicago, IL, 60612, USA
| | - Bjoern Becker
- Department of Gastroenterology, Cantonal Hospital Winterthur, Brauerstr. 15, 8401, Winterthur, Switzerland
| | - Robert Van Dam
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Xavier Keutgen
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653 W. Congress Pkwy, Jelke Building 7th floor, Chicago, IL, 60612, USA
| | - Erik Schadde
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653 W. Congress Pkwy, Jelke Building 7th floor, Chicago, IL, 60612, USA. .,Department of Surgery, Cantonal Hospital Winterthur, Brauerstr. 15, 8401, Winterthur, Switzerland.
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30
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Skertich NJ, Gerard J, Poirier J, Hertl M, Pappas SG, Schadde E, Keutgen XM. Do All Abdominal Neuroendocrine Tumors Require Extended Postoperative VTE Prophylaxis? A NSQIP Analysis. J Gastrointest Surg 2019; 23:788-793. [PMID: 30671795 DOI: 10.1007/s11605-018-04075-y] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/27/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) occurs at high incidence in abdominal cancer surgery; therefore, a 4-week postoperative VTE prophylaxis is advocated. However, most patients with neuroendocrine tumors (NETs) have more favorable prognoses. This study aimed to determine the incidence of VTE in patients with abdominal NETs, compare these rates to other abdominal malignancies, and identify VTE risk factors. METHODS The ACS-NSQIP database was queried to identify patients with abdominal NETs and other abdominal malignancies who underwent surgery from 2008 to 2015. A 30-day postoperative VTE incidence for each group was compared. Univariable and multivariable analyses were used to identify VTE risk factors. RESULTS Of the 7226 operations for patients with benign (2154) and malignant (5072) abdominal NETs, 144 patients experienced a VTE without significant differences between groups. Subgroup analysis revealed a spectrum of VTE rates. Compared to VTE rates of other abdominal malignancies, patients with benign (1.1% vs. 2.4%, p < 0.001) or malignant (1.7% vs. 2.4%, p < 0.001) non-pancreatic abdominal NETs had significantly lower rates, malignant pancreatic NETs (PNETs) (3.4% vs. 2.4%, p = 0.03) had significantly higher rates, and benign PNETs (3.2% vs. 2.4%, p = 0.21) had comparable rates. Multivariable analysis identified pre-operative albumin (p < 0.001), bleeding disorders (p < 0.001), operative time (p < 0.001), and having a PNET (p = 0.04) as risk factors for VTE in abdominal NET patients. CONCLUSION Routine extended VTE prophylaxis after surgery may be necessary in PNETs, but probably unnecessary in other abdominal NETs. However, clinicians should use risk factors identified in this study when considering to forego extended VTE prophylaxis in NET patients.
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Affiliation(s)
- Nicholas J Skertich
- Department of Surgery, Division of Surgical Oncology, Rush University Medical Center, 1750 W. Harrison Street, Jelke Building Suite 785, Chicago, IL, 60612, USA
| | - Justin Gerard
- Department of Surgery, Division of Surgical Oncology, Rush University Medical Center, 1750 W. Harrison Street, Jelke Building Suite 785, Chicago, IL, 60612, USA
| | - Jennifer Poirier
- Department of Surgery, Division of Surgical Oncology, Rush University Medical Center, 1750 W. Harrison Street, Jelke Building Suite 785, Chicago, IL, 60612, USA
| | - Martin Hertl
- Department of Surgery, Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sam G Pappas
- Department of Surgery, Division of Surgical Oncology, Rush University Medical Center, 1750 W. Harrison Street, Jelke Building Suite 785, Chicago, IL, 60612, USA
| | - Erik Schadde
- Department of Surgery, Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Xavier M Keutgen
- Department of Surgery, Division of General Surgery and Surgical Oncology, Endocrine Research Program, The University of Chicago Medicine and Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
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31
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Tierney JF, Chivukula SV, Wang X, Pappas SG, Schadde E, Hertl M, Poirier J, Keutgen XM. Resection of primary tumor may prolong survival in metastatic gastroenteropancreatic neuroendocrine tumors. Surgery 2019; 165:644-651. [DOI: 10.1016/j.surg.2018.09.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/11/2018] [Accepted: 09/05/2018] [Indexed: 12/30/2022]
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Schadde E, Guiu B, Deal R, Kalil J, Arslan B, Tasse J, Olthof PB, Heil J, Schnitzbauer AA, Jakate S, Breitenstein S, Schläpfer M, Beck Schimmer B, Hertl M. Simultaneous hepatic and portal vein ligation induces rapid liver hypertrophy: A study in pigs. Surgery 2019; 165:525-533. [PMID: 30482517 DOI: 10.1016/j.surg.2018.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Liver hypertrophy induced by partial portal vein occlusion (PVL) is accelerated by adding simultaneous parenchymal transection ("ALPPS procedure"). This preclinical experimental study in pigs tests the hypothesis that simultaneous ligation of portal and hepatic veins of the liver also accelerates regeneration by abrogation of porto-portal collaterals without need for operative transection. METHODS A pig model of portal vein occlusion was compared with the novel model of simultaneous portal and hepatic vein occlusion, where major hepatic veins draining the portal vein-deprived lobe were identified with intraoperative ultrasonography and ligated using pledgeted transparenchymal sutures. Kinetic growth was compared, and the portal vein system was then studied after 7 days using epoxy casts of the portal circulation. Portal vein flow and portal pressure were measured, and Ki-67 staining was used to evaluate the proliferative response. RESULTS Pigs were randomly assigned to portal vein occlusion (n = 8) or simultaneous portal and hepatic vein occlusion (n = 6). Simultaneous portal and hepatic vein occlusion was well tolerated and led to mild cytolysis, with no necrosis in the outflow vein-deprived liver sectors. The portal vein-supplied sector increased by 90 ± 22% (mean ± standard deviation) after simultaneous portal and hepatic vein occlusion compared with 29 ± 18% after PVL (P < .001). Collaterals to the deportalized liver developed after 7 days in both procedures but were markedly reduced in simultaneous portal and hepatic vein occlusion. Ki-67 staining at 7 days was comparable. CONCLUSION This study in pigs found that simultaneous portal and hepatic vein occlusion led to rapid hypertrophy without necrosis of the deportalized liver. The findings suggest that the use of simultaneous portal and hepatic vein occlusion accelerates liver hypertrophy for extended liver resections and should be evaluated further.
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Affiliation(s)
- Erik Schadde
- Department of Surgery, Rush University Medical Center, Chicago, IL; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland; Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Switzerland.
| | - Boris Guiu
- Department of Radiology, St. Eloi University Hospital, Montpellier, France
| | - Rebecca Deal
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Jennifer Kalil
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Bulent Arslan
- Department of Radiology, Interventional Radiology, Rush University Medical Center, Chicago, IL
| | - Jordan Tasse
- Department of Radiology, Interventional Radiology, Rush University Medical Center, Chicago, IL
| | - Pim B Olthof
- Department of Experimental Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Heil
- Department of Surgery, Johann Wolfgang Goethe University Medical Center, Frankfurt, Germany
| | - Andreas A Schnitzbauer
- Department of Surgery, Johann Wolfgang Goethe University Medical Center, Frankfurt, Germany
| | - Shriram Jakate
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | | | - Martin Schläpfer
- Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Beatrice Beck Schimmer
- Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Martin Hertl
- Department of Surgery, Rush University Medical Center, Chicago, IL
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Tierney JF, Poirier J, Chivukula S, Pappas SG, Hertl M, Schadde E, Keutgen X. Primary Tumor Site Affects Survival in Patients with Gastroenteropancreatic and Neuroendocrine Liver Metastases. Int J Endocrinol 2019; 2019:9871319. [PMID: 30992703 PMCID: PMC6434277 DOI: 10.1155/2019/9871319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/21/2019] [Accepted: 02/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are commonly present with metastatic disease, and the liver is the most frequent metastatic site. Herein, we studied whether primary tumor site affects survival in patients with GEP-NETs and liver metastases (NELM). As a secondary endpoint, we studied whether extrahepatic disease and surgical resection impact survival in this patient population. METHODS Patients with NELM diagnosed from 2006 to 2014 were identified from the National Cancer Database. Kaplan-Meier curves and nested Cox proportional hazards were used to assess variables associated with survival. RESULTS 2947 patients with well- or moderately differentiated GEP-NETs and NELM met the inclusion criteria for this study. Patients with small bowel NETs survived the longest of all GEP-NETs with NELM (median not reached). Rectal and gastric NETs with NELM had the shortest survival (median 31 months). Patients with extrahepatic metastases who underwent any operation survived longer than those managed nonoperatively (median survival 38.7 months vs. 18.6 months, p = 0.01). On multivariable analysis, operations on the primary tumor and distant metastatic site (HR 0.23-0.43 vs. no surgery), treatment at an academic/research hospital, Charlson comorbidity index of 0, no extrahepatic metastases, and younger age were associated with prolonged survival (p < 0.01). CONCLUSIONS Primary tumor site affects survival in patients with GEP-NETs and NELM. Surgical resection seems beneficial for all GEP-NETs with NELM, even in the presence of extrahepatic metastases.
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Affiliation(s)
- John F. Tierney
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer Poirier
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sitaram Chivukula
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sam G. Pappas
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Martin Hertl
- Division of Transplant, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Erik Schadde
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
- Division of Transplant, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
- Cantonal Hospital Winterthur, Department of Surgery, Winterthur, Zurich, Switzerland
- University of Zurich, Institute of Physiology, Zurich, Switzerland
| | - Xavier Keutgen
- Division of General Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago, IL, USA
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Schürner AM, Manzini G, Bueter M, Schadde E, Beck-Schimmer B, Schläpfer M. Perioperative surgery- and anaesthesia-related risks of laparoscopic Roux-en-Y gastric bypass - a single centre, retrospective data analysis. BMC Anesthesiol 2018; 18:190. [PMID: 30545308 PMCID: PMC6293573 DOI: 10.1186/s12871-018-0654-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022] Open
Abstract
Background Conservative obesity treatment often leads to limited results. Bariatric surgery is highly efficient, but the candidates are at risk of developing perioperative complications. Bariatric outcomes have been well described in the past, but there are only few reports of perioperative outcomes. The aim of this study was to evaluate the incidence of anaesthetic and surgical complications of Roux-en-Y bypass. Methods Data of all adult patients, who underwent primary Roux-en-Y gastric bypass surgery between 1/2006 and 12/2013 at the University Hospital Zurich were analysed. Using our clinical database, anaesthetic and surgical complications during the first 30 days after surgery were analysed and risk factors determined by multivariate analysis. Results Seven hundred eleven patients (72% female, median age 40 years) were analysed. Overall, surgical complications occurred in 34% patient, while complications attributable to anaesthesia occurred in 37%. Post-operative nausea and vomiting (PONV) were observed in 34%, intubation-related complications in 4%, and delayed extubation in 2% of our patients. Within the first 30 days after surgery, 22% of the patients presented with an infection. Gastrointestinal complications were found in 8%, and bleeding complications in 3%. Anaesthesia complications were less common in older patients and in patients anaesthetized with a volatile anaesthetic. Severe complications were more common in patients with a lower body mass index (BMI) and with longer surgery. The risk to develop a postoperative infection was higher in diabetic patients. Conclusion Roux-en-Y bariatric surgery has few anaesthetic complications, the most common is PONV. PONV is more common in younger patients and not more common with volatile anaesthetics. Major complications are overall rare and occur in patients with lower BMI and longer surgery, likely reflecting more difficult procedures. Electronic supplementary material The online version of this article (10.1186/s12871-018-0654-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna M Schürner
- Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Giulia Manzini
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Surgery, Cantonal Hospital Olten, Baslerstrasse 150, 4600, Olten, Switzerland
| | - Marco Bueter
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Erik Schadde
- Institute of Physiology, University Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Rush University Medical Center, 1653 W. Congress Pkwy, Chicago, IL, 60612-3244, USA.,Department of Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Beatrice Beck-Schimmer
- Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Institute of Physiology, University Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Department of Anaesthesiology, University of Illinois at Chicago, 1740 West Taylor Street Suite 3200W, MC 515, Chicago, IL, 60612, USA
| | - Martin Schläpfer
- Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Institute of Physiology, University Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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Keutgen XM, Schadde E, Pommier RF, Halfdanarson TR, Howe JR, Kebebew E. Metastatic neuroendocrine tumors of the gastrointestinal tract and pancreas: A surgeon's plea to centering attention on the liver. Semin Oncol 2018; 45:232-235. [PMID: 30318110 DOI: 10.1053/j.seminoncol.2018.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/18/2018] [Indexed: 02/03/2023]
Abstract
Over 50% of patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have stage IV disease at presentation and the most likely organ to be affected by metastases is the liver. Hepatic involvement and hepatic tumor burden is a key prognostic factor affecting survival of these patients and 80% eventually die of liver failure due to tumor dissemination within the liver. This commentary explores the efficacy and limitations of systemic treatments in patients with GEP-NETs and liver metastases. Landmark randomized trials using systemic therapies including sandostatin (PROMID), lanreotide (CLARINET), everolimus (RADIANT 3 and 4), sunitinib and Peptide Receptor Radionuclide Therapy (NETTER-1) have not shown efficacy in reducing liver tumor burden in patients with stage IV GEP-NETs with liver metastases as outlined in this review. Although often overlooked, surgical debulking has been associated with a significant survival advantage in large retrospective studies and in our opinion should remain an important therapeutic option for patients with stage IV GEP-NETs and liver metastases.
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Affiliation(s)
- Xavier M Keutgen
- Rush University Medical Center, Department of Surgery, Division of Surgical Oncology, Chicago, IL, USA.
| | - Erik Schadde
- Rush University Medical Center, Department of Surgery, Division of Surgical Oncology, Chicago, IL, USA; Cantonal Hospital Winterthur, Department of Surgery, Winterthur, Zurich, Switzerland; University of Zurich, Institute of Physiology, Zurich, Switzerland
| | - Rodney F Pommier
- Oregon Health & Science University, Department of Surgery, Division of Surgical Oncology, Portland, OR, USA
| | | | - James R Howe
- University of Iowa, Department of Surgery, Division of Surgical Oncology, Iowa City, IA, USA
| | - Electron Kebebew
- Stanford University, Department of Surgery, Division of Surgical Oncology, Stanford, CA, USA
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Tierney JF, Chivukula SV, Poirier J, Pappas SG, Schadde E, Kebebew E, Keutgen XM. National Treatment Trends for Adrenocortical Cancer in the US: Have We Made Any Progress? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Olthof PB, Schnitzbauer AA, Schadde E. The HPB controversy of the decade: 2007-2017 - Ten years of ALPPS. Eur J Surg Oncol 2018; 44:1624-1627. [PMID: 29954639 DOI: 10.1016/j.ejso.2018.06.005] [Citation(s) in RCA: 27] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 12/12/2022] Open
Abstract
Ten years ago the first patient underwent Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS). This report aimed to critically review literature on ALPPS in terms of methods, outcomes, and bias. In total, 237 English papers on ALPPS were identified, 75 (32%) were letters and 43 (18%) case-reports. Forty-nine single-center series reported a median 10 patients, with 0-69% morbidity and 0-50% mortality. The indications for ALPPS were reported in 35% and 47% reported on modifications. Twenty-three multicenter series included a median 45 patients. Some reports excluded up to 399 cases. 26% reported on the indications and 35% on ALPPS modifications. Across journals, variation in positive and negative conclusions on ALPPS was observed. Ten years of ALPPS have resulted in diverse publications with a high concern of bias. Although one randomized study has been published, a more critical approach towards retrospective methodology is needed to allow pragmatic conclusions for HPB-surgeons.
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Affiliation(s)
- Pim B Olthof
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands; Department of Experimental Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - Andreas A Schnitzbauer
- Frankfurt University Hospital, Goethe-University Frankfurt/Main, Clinic for General and Visceral Surgery, Frankfurt/Main, Germany
| | - Erik Schadde
- Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland; Department of Surgery, Rush University Medical Center, Chicago, IL, United States
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Schnitzbauer AA, Schadde E, Linecker M, Machado MA, Adam R, Malago M, Clavien PA, de Santibanes E, Bechstein WO. Indicating ALPPS for Colorectal Liver Metastases: A Critical Analysis of Patients in the International ALPPS Registry. Surgery 2018; 164:387-394. [PMID: 29803563 DOI: 10.1016/j.surg.2018.02.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES In the international associating liver partition and portal vein ligation for staged hepatectomy registry, more than 50% of patients underwent associating liver partition and portal vein ligation for staged hepatectomy with a right hepatectomy. This study evaluated the necessity of two-stage hepatectomies being performed as right hepatectomy associating liver partition and portal vein ligation for staged hepatectomy in patients with colorectal liver metastases versus right trisectionectomy associating liver partition and portal vein ligation for staged hepatectomy. PATIENTS AND METHODS All patients registered between 2012 and 2017 undergoing associating liver partition and portal vein ligation for staged hepatectomy for colorectal liver metastases were included. A liver to body weight index of 0.5 or less prior to stage I in the presence of liver damage was used as an internationally accepted standard to justify a two-stage hepatectomy. RESULTS Four-hundred and three patients with colorectal liver metastases with right hepatectomy associating liver partition and portal vein ligation for staged hepatectomy (n = 183) or right trisectionectomy associating liver partition and portal vein ligation for staged hepatectomy (n = 220) were analyzed. Presence of metastases in segments II/III, liver damage, number of patients on chemotherapy, and cycles were comparable, and there was a comparable response to chemotherapy. Liver to body weight index was different prior to stage 1 (right trisectionectomy associating liver partition and portal vein ligation for staged hepatectomy: 0.33 ± 0.12 versus right hepatectomy associating liver partition and portal vein ligation for staged hepatectomy: 0.40 ± 0,14; P < .001) and prior to stage 2 (right trisectionectomy associating liver partition and portal vein ligation for staged hepatectomy: 0.58 ± 0.17 versus right hepatectomy associating liver partition and portal vein ligation for staged hepatectomy: 0.66 ± 0,18; P < .001). Hypertrophy rates were similar between groups. As much as 16.9% and 7.2% of patients in right hepatectomy associating liver partition and portal vein ligation for staged hepatectomy and right trisectionectomy associating liver partition and portal vein ligation for staged hepatectomy had no apparent justification for a two-stage hepatectomy based on LBWI prior to stage 1 and absence of chemotherapy (<12 cycles). CONCLUSION More than 15% of associating liver partition and portal vein ligation for staged hepatectomy procedures were performed in patients who may have had no indication for a two-stage hepatectomy, especially in the group of patients with right hepatectomy. Thus, it appears that there is a risk of the overuse of associating liver partition and portal vein ligation for staged hepatectomy because of its great potential to induce volume growth. Due to the high perioperative risk of associating liver partition and portal vein ligation for staged hepatectomy, indications should be carefully reconsidered.
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Affiliation(s)
- Andreas A Schnitzbauer
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Clinic for General and Visceral Surgery, Germany.
| | - Erik Schadde
- Rush University Medical Center, Department of Transplant Surgery, Department of Surgery, Chicago, IL, USA
| | - Michael Linecker
- University Hospital Zurich, Swiss HPB and Transplant Center, Zurich, Switzerland
| | - Marcel A Machado
- Department of Surgery, University of Sao Paolo, Sirio Libanes Hospital, Sao Paolo, Brazil
| | - Rene Adam
- AP-HP, Hôpital Paul Brousse, U Inserm 935, Univ Paris-Sud, Villejuif Cedex, Paris, France
| | - Massimo Malago
- Royal Free Hospital, University College London, Department of HPB and Liver Transplant Surgery, London, UK
| | - Pierre A Clavien
- University Hospital Zurich, Swiss HPB and Transplant Center, Zurich, Switzerland
| | - Eduardo de Santibanes
- Italian Hospital Buenos Aires, Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Buenos Aires, Argentina
| | - Wolf O Bechstein
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Clinic for General and Visceral Surgery, Germany
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Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, Costas-Chavarri A, Drake TM, Ntirenganya F, Fitzgerald JE, Fergusson SJ, Glasbey J, Ingabire JCA, Ismaïl L, Salem HK, Kojo ATT, Lapitan MC, Lilford R, Mihaljevic AL, Morton D, Mutabazi AZ, Nepogodiev D, Adisa AO, Ots R, Pata F, Pinkney T, Poškus T, Qureshi AU, Ramos-De la Medina A, Rayne S, Shaw CA, Shu S, Spence R, Smart N, Tabiri S, Harrison EM, Khatri C, Mohan M, Jaffry Z, Altamini A, Kirby A, Søreide K, Recinos G, Cornick J, Modolo MM, Iyer D, King S, Arthur T, Nahar SN, Waterman A, Walsh M, Agarwal A, Zani A, Firdouse M, Rouse T, Liu Q, Correa JC, Talving P, Worku M, Arnaud A, Kalles V, Kumar B, Kumar S, Amandito R, Quek R, Ansaloni L, Altibi A, Venskutonis D, Zilinskas J, Poskus T, Whitaker J, Msosa V, Tew YY, Farrugia A, Borg E, Bentounsi Z, Gala T, Al-Slaibi I, Tahboub H, Alser OH, Romani D, Shu S, Major P, Mironescu A, Bratu M, Kourdouli A, Ndajiwo A, Altwijri A, Alsaggaf MU, Gudal A, Jubran AF, Seisay S, Lieske B, Ortega I, Jeyakumar J, Senanayake KJ, Abdulbagi O, Cengiz Y, Raptis D, Altinel Y, Kong C, Teasdale E, Irwin G, Stoddart M, Kabariti R, Suresh S, Gash K, Narayanan R, Maimbo M, Grizhja B, Ymeri S, Galiqi G, Klappenbach R, Antezana D, Mendoza Beleño AE, Costa C, Sanchez B, Aviles S, Fermani CG, Balmaceda R, Villalobos S, Carmona JM, Hamill D, Deutschmann P, Sandler S, Cox D, Nataraja R, Sharpin C, Ljuhar D, Gray D, Haines M, Iyer D, Niranjan N, D'Amours S, Ashtari M, Franco H, Rahman Mitul A, Karim S, Aman NF, Estee MM, Salma U, Razzaque J, Hamid Kanta T, Tori SA, Alamin S, Roy S, Al Amin S, Karim R, Haque M, Faruq A, Iftekhar F, O'Shea M, Padmore G, Jonnalagadda R, Litvin A, Filatau A, Paulouski D, Shubianok M, Shachykava T, Khokha D, Khokha V, Djivoh F, Dossou F, Seto DM, Gbessi DG, Noukpozounkou B, Imorou Souaibou Y, Keke KR, Hodonou F, Ahounou EYS, Alihonou T, Dénakpo M, Ahlonsou G, Ginbo Bedada A, Nsengiyumva C, Kwizera S, Barendegere V, Choi P, Stock S, Jamal L, Azzie G, Kushwaha S, Chen TL, Yip C, Montes I, Zapata F, Sierra S, Villegas Lanau MI, Mendoza Arango MC, Mendoza Restrepo I, Restrepo Giraldo RS, Domini E, Karlo R, Mihanovic J, Youssef M, Elfeki H, Thabet W, Sanad A, Tawfik G, Zaki A, Abdel-Hameed N, Mostafa M, Omar MFW, Ghanem A, Abdallah E, Denewer A, Emara E, Rashad E, Sakr A, Elashry R, Emile S, Khafagy T, Elhamouly S, Elfarargy A, Mamdouh Mohamed A, Saied Nagy G, Esam A, Elwy E, Hammad A, Khallaf S, Ibrahim E, Said Badr A, Moustafa A, Eldosouky Mohammed A, Elgheriany M, Abdelmageed E, Al Raouf EA, Samir Elbanby E, Elmasry M, Morsy Farahat M, Yahya Mansor E, Magdy Hegazy E, Gamal E, Gamal H, Kandil H, Maher Abdelrouf D, Moaty M, Gamal D, El-Sagheer N, Salah M, Magdy S, Salah A, Essam A, Ali A, Badawy M, Ahmed S, Mohamed M, Assal A, Sleem M, Ebidy M, Abd-Elrazek A, Zahran D, Adam N, Nazir M, Hassanein AB, Ismail A, Elsawy A, Mamdouh R, Mabrouk M, Ahmed LAM, Hassab Alnaby M, Magdy E, Abd-Elmawla M, Fahim M, Mowafy B, Ibrahim Mahmoud M, Allam M, Alkelani M, Halim El Gendy N, Saad Aboul-Naga M, Alaa El-Din R, Elgendy AH, Ismail M, Shalaby M, Adel Elsharkawy A, Elsayed Moghazy M, Hesham Elbisomy K, Abdel Gawad Shakshouk H, Hamed MF, Ebidy MM, Abdelkader M, Karkeet M, Ahmed H, Adel I, Omar ME, Ibrahim M, Ghoneim O, Hesham O, Gamal S, Hilal K, Arafa O, Adel Awad S, Salem M, Abdellatif Elsherif F, Elsabbagh N, Aboelsoud MR, Hossam Eldin Fouad Rida A, Hossameldin A, Hany E, Hosny Asar Y, Anwar N, Gadelkarim M, Abdelhady S, Mohamed Morshedy E, Saad R, Soliman N, Salama M, Ezzat E, Mohamed A, Ibrahim A, Fergany A, Mohammed S, Reda A, Allam Y, Saad HA, Abdelfatah A, Fathy AM, El-Sehily A, Abdalmageed Kasem E, Hassan ATA, Mohammed AR, Saad AG, Elfouly Y, Elfouly N, Ibrahim A, Hassaan A, Mohammed MM, Elhoseny G, Magdy M, Abd Elkhalek E, Zakaria Y, Ezzat T, Abo El Dahab A, Kelany M, Arafa S, Mokhtar Mohamed Hassan O, Mohamed Badwi N, Saber Sleem A, Ahmed H, Abdelbadeai K, Abozed Abdullah M, Lokman MAA, Bahar S, Rady Abdelazeam A, Adelshone A, Bin Hasnan M, Zulkifli A, Kamarulzamil SNA, Elhendawy A, Latif A, Bin Adnan A, Shaharuddin S, Haji Abdul Majid AH, Amreia M, Al-Marakby D, Salma M, Ismail MJB, Mohd Basir ER, Mohd Ali CD, Ata AY, Nasr M, Rezq A, Sheta A, Tariq S, Sallam AE, Darwish AKZ, Elmihy S, Elhadry S, Farag A, Hajeh H, Abdelaal A, Aglan A, Zohair A, Essam M, Moussa O, El-Gizawy E, Samy M, Ali S, El Halawany E, Ata A, El Halawany M, Nashat M, Soliman S, Elazab A, Samy M, Abdelaziz MA, Ibrahim K, Ibrahim AM, Gado A, Hantour U, Alm Eldeen E, Loaloa MR, Abouzaid A, Ahmed Bahaa Eldin M, Hashad E, Sroor F, Gamil D, Mahmoud Abdulhakeem E, Zakaria M, Mohamed F, Abubakr M, Ali E, Magdy H, Ramadan MT, Abdelaty Mohamed M, Mansour S, Abdul Aziz Amin H, Rabie Mohamed A, Saami M, Ahmed Reda Elsayed N, Tarek A, Mohy Eldeen Mahmoud S, Magdy El Sayed I, Reda A, Yusuf Shawky M, Mousa Salem M, Alaa El-Din S, Abdullah Soliman N, Talaat M, Alaael-Dein S, Abd Elmoen Elhusseiny A, Abdullah N, Elshaar M, Abdelfatah Ibraheem A, Abdulaziz H, Kamal Ismail M, Hamdy Madkor M, Abdelaty M, Mahmoud Abdel-Kader S, Mohamed Salah O, Eldafrawy M, Zaki Eldeeb A, Mahmoud Eid M, Attia A, Salah El-Dien K, Shwky A, Badenjki MA, Soliman A, Mahmoud Al Attar S, Sayed F, Abdel Sabour F, Azizeldine MG, Shawqi M, Hashim A, Aamer A, Abdelraouf AM, Abdelshakour M, Ibrahim A, Mahmoud B, Ali Mahmoud M, Qenawy M, Rashed AM, Dahy A, Sayed M, Shamsedine AW, Mohamed B, Hasan A, Saad MM, Abdul Bassit K, Khalid Abd El-Latif N, Elzahed N, El Kashash A, Bekhet NM, Hafez S, Gad A, Maher ME, Abd El-Sameea A, Hafez M, Sabe A, Ahmed A, Shahine A, Dawood K, Gaafar S, Husseiny R, Aboelmagd O, Soliman A, Mesbah N, Emadeldin H, Al Meligy A, Bekhet AH, Hasan D, Alhady K, Sabe AK, Elnajjar MA, Aboelella M, Hamsho W, Hassan I, Saad H, Abdelazim G, Mahmoud H, Wael N, Kandil AM, Magdy A, Said Elkholy S, Adel BE, Dabbour K, Elsherbiney S, Mattar O, Khaled AbdRabou A, Aly MYM, Geuoshy A, Elnagar A, Ahmed S, Abdelmotaleb I, Saleh AA, Mohammed Bakry H, Saeed M, Mahmoud S, Tawfik BA, Ismail SA, Zakaria E, Gad MO, Salah Elhelbawy M, Bassem M, Maraie N, Medhat Elhadary N, Semeda N, Rabie Mohamed S, Bakry HM, Essam AA, Tarek D, Ashour K, Elhadad A, Abdel-Aty A, Rakha I, Mamdouh Matter S, Abdelhamed R, Abdelkader O, Hassaan A, Soliman Y, Mohamed A, Ghanem S, Amr Mohamed Farouk S, Ibrahim EM, El-Taher E, Mostafa M, Mahrous Badr MF, Elsemelawy R, El-Sawy A, Bakr A, Al Rafati AAR, Saar S, Reinsoo A, Seyoum N, Worku T, Fitsum A, Tolonen M, Leppäniemi A, Sallinen V, Parmentier B, Peycelon M, Irtan S, Dardenne S, Robert E, Maillot B, Courboin E, Arnaud AP, Hascoet J, Abbo O, Ait Kaci A, Prudhomme T, Ballouhey Q, Grosos C, Fourcade L, Cecilia T, Jean-Francois C, Helene FC, Delforge X, Haraux E, Dousset B, Schiavone R, Gaujoux S, Marret JB, Haffreingue A, Rod J, Renaux-Petel M, Lecompte JF, Bréaud J, Gastaldi P, Taieb C, Claire R, Anis E, Bustangi N, Lopez M, Scalabre A, Grella MG, Mariani A, Podevin G, Schmitt F, Hervieux E, Broch A, Muller C, Bandoh D, Abantanga F, Kyereh M, Asumah H, Appiah EK, Wondoh P, Gyedu A, Dally C, Agbedinu K, Amoah M, Yifieyeh A, Agbedinu K, Owusu F, Amoako-Boateng M, Dayie M, Hagan R, Debrah S, Ohene-Yeboah M, Clegg-Lampety JN, Etwire V, Dakubo J, Essoun S, Bonney W, Glover-Addy H, Osei-Nketiah S, Amoako J, Adu-Aryee N, Appeadu-Mensah W, Bediako-Bowan A, Dedey F, Ekow M, Akatibo E, Yakubu M, Kordorwu HEK, Asare-Bediako K, Tackie E, Aaniana K, Acquah E, Opoku-Agyeman R, Avoka A, Kusi K, Maison K, Gyamfi FE, Naa Barnabas G, Abdul-Latif S, Taah Amoako P, Davor A, Dassah V, Dagoe E, Kwakyeafriyie P, Akoto E, Ackom E, Mensah E, Atkins ET, Coompson CL, Ivros N, Ferousis C, Kalles V, Agalianos C, Kyriazanos I, Barkolias C, Tselos A, Tzikos G, Voulgaris E, Lytras D, Bamicha A, Psarianos K, Stefanopoulos A, Patoulias I, Sfougaris D, Valioulis I, Balalis D, Korkolis D, Manatakis DK, Kyrou G, Karabelias G, Papaskarlatos IA, Konstantina K, Zampitis N, Germanos S, Papailia A, Theodosopoulos T, Gkiokas G, Mitroudi M, Panteli C, Feidantsis T, Farmakis K, Kyziridis D, Ioannidis O, Parpoudi S, Gemenetzis G, Parasyris S, Anthoulakis C, Nikoloudis N, Margaritis M, Aguilera-Arevalo ML, Coyoy-Gaitan O, Rosales J, Tale L, Soley R, Barrios E, Rodriguez STT, Paz Galvez C, Herrera Cruz D, Sanchez Rosenberg G, Matheu A, Cohen DM, Paul M, Charles A, Lam JCY, Yeung MHA, Fok CYJ, Li KHG, Lai ACH, Cheung YHE, Wong HY, Leung KW, Lee TSB, Lam WH, Dao W, Kwok SHW, Chan TYK, Ng YK, Mak TWC, Foo CC, Yang J, Bhatnagar A, Upadhyaya V, Muddebihal U, Dar W, Janardhan KC, Aruldas N, Adella FJ, Rulie AS, Iskandar F, Setiawan J, Evajelista CV, Natalie H, Suyadi A, Gunawan R, Karismaningtyas H, Mata LPS, Andika FFA, Hasanah A, Widiastini TA, Purwaningsih NA, Mukin ADF, Rahmah DF, Nurqistan HD, Arsyad HM, Adhitama N, Jeo WS, Sutandi N, Clarissa A, Gultom PA, Billy M, Haloho A, Johanna N, Lee F, Radin Dorani RMN, Glynn M, Alherz M, Goh W, Shiwani HA, Sproule L, Conlon KC, Bala M, Kedar A, Turati L, Bianco F, Steccanella F, Gallo G, Trompetto M, Clerico G, Papandrea M, Sammarco G, Sacco R, Benevento A, Giavarini L, Giglio MC, Bucci L, Pagano G, Sollazzo V, Peltrini R, Luglio G, Birindelli A, Di Saverio S, Tugnoli G, Paludi MA, Mingrone P, Pata D, Selvaggi F, Selvaggi L, Pellino G, Di Martino N, Curletti G, Aonzo P, Galleano R, Berti S, Francone E, Boni S, Lorenzon L, lo Conte A, Balducci G, Confalonieri G, Pesenti G, Gavagna L, Vasquez G, Targa S, Occhionorelli S, Andreotti D, Pata G, Armellini A, Chiesa D, Aquilino F, Chetta N, Picciariello A, Abdelkhalek M, Belli A, De Franciscis S, Bigaran A, Favero A, Basso SMM, Salusso P, Perino M, Mochet S, Sasia D, Riente F, Migliore M, Merlini D, Basilicò S, Corbellini C, Lazzari V, Macchitella Y, Bonavina L, Angelieri D, Coletta D, Falaschi F, Catani M, Reali C, Malavenda M, Del Basso C, Ribaldi S, Coletti M, Natili A, Depalma N, Iannone I, Antoniozzi A, Rossi D, Gui D, Perrotta G, Ripa M, Giardino FR, Foco M, Vicario E, Coccolini F, Nita GE, Leone N, Bondurri A, Maffioli A, Simioni A, De Boni D, Pasquali S, Goldin E, Vendramin E, Ciccioli E, Tedeschi U, Bortolasi L, Violi P, Campagnaro T, Conci S, Lazzari G, Iacono C, Gulielmi A, Manfreda S, Rinaldi A, Ringressi MN, Brunoni B, Salamone G, Mangiapane M, De Marco P, La Brocca A, Tutino R, Silvestri V, Licari L, Fontana T, Falco N, Cocorullo G, Shalaby M, Sileri P, Arcudi C, Bsisu I, Aljboor K, Abusalem L, Alnusairat A, Qaissieh A, Al-Dakka E, Ababneh A, Halhouli O, Yusufali T, Mohammed H, Lando J, Parker R, Ndegwa W, Jokubauskas M, Gribauskaite J, Kuliavas J, Dulskas A, Samalavicius NE, Jasaitis K, Parseliunas A, Nevieraite V, Montrimaite M, Slapelyte E, Dainius E, Riauka R, Dambrauskas Z, Subocius A, Venclauskas L, Gulbinas A, Bradulskis S, Kasputyte S, Mikuckyte D, Kiudelis M, Jankus T, Petrikenas S, Pažuskis M, Urniežius Z, Vilčinskas M, Banaitis VJ, Gaižauskas V, Grisin E, Mazrimas P, Rackauskas R, Drungilas M, Lagunavicius K, Lipnickas V, Majauskyté D, Jotautas V, Abaliksta T, Uščinas L, Simutis G, Ladukas A, Danys D, Laugzemys E, Mikalauskas S, Zdanyte Sruogiene E, Višinskas P, Žilinskienė R, Dragatas D, Burmistrovas A, Tverskis Z, Vaicius A, Mazelyte R, Zadoroznas A, Kaselis N, Žiubrytė G, Rahantasoa FCFP, Samison LH, Rasoaherinomenjanahary F, Tolotra TEC, Mukuzunga C, Kwatiwani C, Msiska N, Chai FY, Asilah SMD, Syibrah KZ, Chin PX, Salleh A, Riswan NZ, Roslani AC, Chong HY, Aziz NA, Poh KS, Chai CA, Kumar S, Taher MM, Kosai NR, Abdul Aziz DN, Rajan R, Julaihi R, Jethwani DL, Yahaya MT, Nik Abdullah NA, Mathew SW, Chung KJ, Nirumal MK, Ern Tze RG, Wan Ali SAWE, Gan YY, Ting JRS, Sii SSY, Koay KL, Tan YK, Cheah AEZ, Wong CY, Tuan Mat TN, Chow CYN, Har PAL, Der Y, Henry F, Low X, Neo YT, Heng HE, Kong SN, Gan C, Mok YT, Tan YW, Palayan K, Deva Tata M, Cheong YJ, Gunaseelan K, Wan Mohd Nasir WN'A, Yoganathan P, Lee EX, Saw JE, Yeang LJ, Koh PY, Lim SY, Teo SY, Grech N, Magri D, Cassar K, Mizzi C, Falzon M, Shaikh N, Scicluna R, Zammit S, Mizzi S, Brincat SD, Tembo T, Hien Le VT, Grima T, Sammut K, Carabott K, Zarb C, Navarro A, Dimech T, Camilleri GM, Bertuello I, Dalli J, Bonavia K, Corro-Diaz S, Manriquez-Reyes M, Abdelhamid A, Hrora A, Benammi S, Bachri H, Abbouch M, Boukhal K, Bennai RM, Belkouchi A, Jabal MS, Benyaiche C, Vermaas M, Duinhouwer L, Pastora J, Wood G, Merlo MS, Ajao A, Ayandipo O, Lawal T, Abdurrazzaaq A, Alada M, Nasir A, Adeniran J, Habeeb O, Popoola A, Adeyeye A, Adebanjo A, Adesanya O, Adeniyi A, Mendel H, Bello B, Muktar U, Osinowo A, Olajide TO, Oshati O, Ihediwa G, Adenekan B, Nwinee V, Alakaloko F, Elebute O, Lawal A, Bode C, Olugbemi M, Adesina A, Faturoti O, Odutola O, Adebola O, Onuoha C, Taiwo O, Williams O, Balogun F, Ajai O, Oludara M, Njokanma I, Osuoji R, Kache S, Ajah J, Makama J, Adamu A, Baba S, Aliyu M, Aliyu S, Ukwenya Y, Aliyu H, Sholadoye T, Daniyan M, Ogunsua O, Anyanwu LJ, Sheshe A, Mohammad A, Olori S, Mshelbwala P, Odeyemi B, Samson G, Kehinde Timothy O, Ali Samuel S, Ajiboye A, Amole I, Abiola O, Olaolorun A, Veen T, Kanani A, Styles K, Herikstad R, Wiik Larsen J, Søreide JA, Jensen E, Gran M, Aahlin EK, Gaarder T, Monrad-Hansen PW, Næss PA, Lauzikas G, Wiborg J, Holte S, Augestad KM, Banipal GS, Monteleone M, Moe TT, Schultz JK, Nadeem N, Saqlain M, Abbasy J, Alvi AR, Shahzad N, Bhopal KF, Iftikhar Z, Butt MT, ul Razi SA, Ahmed A, Khan Niazi A, Raza I, Baluch F, Raza A, Bani-Sadar A, Adil M, Raza A, Javaid M, Waqar M, Khan MA, Arshad MM, Amjad MA, Al-taher T, Hamdan A, Salman A, Saadeh R, Musleh A, Jaradat D, Abushamleh S, Hanoun S, Abu Qumbos A, Hamarshi A, Taher AA, Qawasmi I, Qurie K, Altarayra M, Ghannam M, Shaheen A, Herebat A, Abdelhaq A, Shalabi A, Abu-toyour M, Asi F, Shamasneh A, Atiyeh A, Mustafa M, Zaa'treh R, Dabboor M, Alaloul E, Baraka H, Meqbil J, Al-Buhaisi A, Elshami M, Afana S, Jaber S, Alyacoubi S, Abuowda Y, Idress T, Abuqwaider E, Al-saqqa S, Bowabsak A, El Jamassi A, Hasanain D, Al-Farram H, Salah M, Firwana A, Hamdan M, Awad I, Ashour A, Al Barrawi FE, Alkhatib A, Al-Faqawi M, Fares M, Elmashala A, Adawi M, Adawi I, Khreishi R, Khreishi R, Ashour A, Ghaben A, Machain Vega GM, Cardozo JT, Roche MO, Pertersen Servin GR, Segovia Lohse HA, Páez Lopez LI, Cardozo RAM, Espinoza F, Pérez Rojas AD, Sanchez D, Samaniego CS, Guevara Torres S, Calua AC, Razuri C, Ortiz N, Rodriguez X, Carrasco N, Saravia F, Shibao Miyasato H, Valcarcel-Saldaña M, Bermúdez YEA, Carpio J, Ruiz Panez W, Toribio Orbegozo PA, Guzmán Dueñas C, Turpo Espinoza K, Sandoval Barrantes AM, Chungui Bravo JA, Fuentes-Rivera L, Fernández C, Málaga B, Ye J, Velasquez R, Salcedo J, Contreras-Vergara AL, Vergara Mejia AG, Gonzales Montejo MS, Escalante Salas MDC, Alcca Ticona W, Vargas M, Manrique Sila GC, Mas R, del Pilar Paucar A, Román Velásquez AJ, Robledo-Rabanal A, Solis LAZ, Turpo Espinoza K, Hamasaki Hamaguchi JL, Florez Farfan ES, Madrid Barrientos LA, Herrera Matta JJ, Mora JJV, Redota MAP, Roxas MF, Maño MJB, Parreno-Sacdalan MD, Almanon CL, Walędziak M, Roszkowski R, Janik M, Lasek A, Radkowiak D, Rubinkiewicz M, Fernandes C, Costa-Maia J, Melo R, Muntean L, Mironescu AS, Vida LC, Popa M, Mircea H, Vartic M, Diaconescu B, Bratu MR, Negoi I, Beuran M, Ciubotaru C, Uzabumwana N, Duhoranenayo D, Jovine E, Zanini N, Landolfo G, Aljiffry M, Idris F, Alghamdi MSA, Maghrabi A, Altaf A, Alkaaki A, Khoja A, Nawawi A, Turkustani S, Khalifah E, Albiety A, Sahel S, Alshareef R, Najjar M, Alzahrani A, Alghamdi A, Alhazmi W, Al Saied G, Alamoudi M, Riaz MM, Hassanain M, Alhassan B, Altamimi A, Alyahya R, Al Subaie N, Al Bastawis F, Altamimi A, Nouh T, Khan R, Radojkovic M, Jeremic L, Nestorovic M, Law JH, Tan KSK, Tan RCK, Tan JK, Joel LWL, Chan XW, Leong FQH, Chong CS, Koh S, Lee KY, Lee KC, Pluke K, Dedekind B, Nashidengo P, Hampton MI, Joosten J, Sobnach S, Roodt L, Sander A, Pape J, Maistry N, Ndwambi P, Kinandu K, Tun M, Du Toit F, Ellison Q, Burger S, Grobler DC, Khulu LB, Moore R, Jennings V, Leusink A, Kariem N, Gouws J, Chu K, Bougard H, Noor F, Dell A, Van Straten S, Khamajeet A, Tshisola SK, Kabongo K, Kong V, Moodley Y, Anderson F, Madiba T, du Plooy F, Hartford L, Chilton G, Karjiker P, Mabitsela ME, Ndlovu SR, Badicel M, Jaich R, Ruiz-Tovar J, Garcia-Florez L, Otero-Díez JL, Ramos Pérez V, Aguado Suárez N, Minguez García J, Corral Moreno S, Collado MV, Jiménez Carneros V, García Septiem J, Gonzalez M, Picardo A, Esteban E, Ferrero E, Espin-Basany E, Blanco-Colino R, Andriola V, Solar García L, Contreras E, García Bernardo C, Pagnozzi J, Sanz S, Miyar de León A, Dorismé A, Rodicio J, Suarez A, Stuva J, Diaz Vico T, Fernandez-Vega L, Soldevila-Verdeguer C, Sena-Ruiz F, Pujol-Cano N, Diaz-Jover P, Garcia-Perez JM, Segura-Sampedro JJ, Pineño-Flores C, Ambrona-Zafra D, Craus-Miguel A, Jimenez-Morillas P, Mazzella A, Jayathilake AB, Thalgaspitiya SPB, Wijayarathna LS, Wimalge PMSN, Sanni HA, Okenabirhie O, Homeida A, Younis A, Omer OA, Abdulaziz M, Mussad A, Adam A, Björklund I, Ahlqvist S, Thorell A, Wogensen F, Sokratous A, Breistrand M, Thorarinsdottir H, Sigurdadottir J, Nikberg M, Chabok A, Hjertberg M, Elbe P, Saraste D, Rutkowski W, Forlin L, Niska K, Sund M, Oswald D, Peros G, Bluelle R, Reinisch K, Frey D, Palma A, Raptis DA, Zumbühl L, Zuber M, Schmid R, Werder G, Nocito A, Gerosa A, Mahanty S, Widmer LW, Müller J, Gübeli A, Zuk G, Gulcicek OB, Vartanoglu T, Kose E, Karahan SR, Aydin MC, Sahbaz NA, Halicioglu I, Alis H, Sapci I, Adiyaman C, Pektaş AM, Cengiz TB, Tansoker I, Işler V, Cevik M, Mutlu D, Ozben V, Ozmen BB, Bayram S, Yolcu S, Kobal BB, Toto ÖF, Çakaloğlu HC, Karabulut K, Mutlu V, Ozkan BB, Celik S, Semiz A, Bodur S, Gül E, Murutoglu B, Yildirim R, Baki BE, Arslan E, Ulusahin M, Guner A, Tomas K, Walker N, Shrimanker N, Cole S, Breslin R, Srinivasan R, Elshaer M, Hunter K, Al-Bahrani A, Liew I, Mairs NG, Rocke A, Dick L, Qureshi M, Chowdhury D, Wright N, Skerritt C, Kufeji D, Ho A, Dissanayake T, Tennakoon A, Ali W, Lim SJ, Tan C, O'Neill S, Jones C, Knight S, Nassif D, Sharma A, Warren O, White R, Mehdi A, Post N, Kalakouti E, Dashnyam E, Stourton F, Mykoniatis I, Currow C, Wong F, Gupta A, Shatkar V, Luck J, Kadiwar S, Smedley A, Wakefield R, Herrod P, Blackwell J, Lund J, Cohen F, Bandi A, Giuliani S, Bond-Smith G, Pezas T, Farhangmehr N, Urbonas T, Perenyei M, Ireland P, Blencowe N, Bowling K, Bunting D, Longstaff L, Keogh K, Jeon H, Iqbal MR, Khosla S, Jeffery A, Perera J, Ibrahem AA, Alhammali T, Salama Y, Oram S, Kidd T, Cullen F, Owen C, Wilson M, Chiu S, Sarafilovic H, Ploski J, Evans E, Abbas A, Kamya S, Ishak N, Bisset C, Andress C, Chin YR, Patel P, Evans D, Haslegrave A, Boggon A, Laurie K, Connor K, Mann T, Mansuri A, Davies R, Griffiths E, Shahbaz AR, Eng C, Din F, L'Heveder A, Park EHG, Ravishankar R, McIntosh K, Yau JD, Chan L, McGarvie S, Tang L, Lim H, Yap S, Park J, Ng ZH, Mirza S, Ang YL, Walls L, Roy C, Paterson-Brown S, Camilleri-Brennan J, Mclean K, D'Souza MS, Pronin S, Henshall DE, Ter EZ, Fouad D, Minocha A, English W, Morgan C, Townsend D, Maciejec L, Mahdi S, Akpenyi O, Hall E, Caydiid H, Rob Z, Abbott T, Torrance HD, Johnston R, Gani MA, Gravante G, Rajmohan S, Majid K, Dindyal S, Smith C, Palliyil M, Patel S, Nicholson L, Harvey N, Baillie K, Shillito S, Kershaw S, Bamford R, Orton P, Reunis E, Tyler R, Soon WC, Jama GM, Dhillon D, Patel K, Nanthakumaran S, Heard R, Chen KY, Barmayehvar B, Datta U, Kamarajah SK, Karandikar S, Iftekhar Tani S, Monaghan E, Donnelly P, Walker M, Parakh J, Blacker S, Kaul A, Paramasivan A, Farag S, Nessa A, Awadallah S, Lim J, Chean Khun Ng J, Kiran RP, Murray A, Etchill E, Dasari M, Puyana J, Haddad N, Zielinski M, Choudhry A, Caliman C, Beamon M, Duane T, Swaroop M, Myers J, Deal R, Schadde E, Hemmila M, Napolitano L, To K, Makupe A, Musowoya J, van der Naald N, Kumwenda D, Reece-Smith A, Otten K, Verbeek A, Prins M, Baquero Suarez AA, Balmaceda R, Deane C, Dijan E, Elfiky M, Koskenvuo L, Thollot A, Limoges B, Capito C, Alexandre C, Kotobi H, Leroux J, Pinnagoda K, Henric N, Azzis O, Rosello O, Francois P, Etienne S, Buisson P, Hmila S, Clegg-Lamptey JN, Imoro O, Abem OE, Papageorgiou D, Soulou V, Asturias S, Peña L, O'Connor DB, Luc AR, Russo AA, Ruzzenente A, Taddei A, Cona C, Bottini C, Pascale G, Rotunno G, Solaini L, Pascale MM, Notarnicola M, Corbellino M, Sacco M, Ubiali P, Cautiero R, Bocchetti T, Muzio E, Guglielmo V, Morandi E, Mao P, de Luca E, Ali FM, Žilinskas J, Strupas K, Kondrotas P, Baltrunas R, Kutkevicius J, Ignatavicius P, Tan CL, Siaw JY, Yam SY, Wilson L, Aziz MRA, Bondin J, Zorrilla CD, Majbar A, Sale D, Abdullahi L, Osagie O, Faboya O, Fatuga A, Taiwo A, Nwabuoku E, Bliksøen M, Khan ZA, Coronel J, Miranda C, Vasquez I, Helguero-Santin LM, Rickard J, Adedeji A, Alqahtani S, Rath M, Van Niekerk M, Koto MZ, Matos-Puig R, Israelsson L, Schuetz T, Yuksek MA, Mericliler M, Ulusahin M, Wolf B, Fairfield C, Yong GL, Whitehurst K, Redgrave N, Musyoka CK, Olivier J, Lee K, Cox M, Farhan-Alanie MMH, Callan R, Chibuye C, Ali THA, Rekhis S, Rommaneh M, Sam ZH, Pugliesi TB, Pardo G, Blanco R. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18:516-525. [PMID: 29452941 PMCID: PMC5910057 DOI: 10.1016/s1473-3099(18)30101-4] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. METHODS This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. FINDINGS Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). INTERPRETATION Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. FUNDING DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
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Deal R, Frederiks C, Williams L, Olthof PB, Dirscherl K, Keutgen X, Chan E, Deziel D, Hertl M, Schadde E. Rapid Liver Hypertrophy After Portal Vein Occlusion Correlates with the Degree of Collateralization Between Lobes-a Study in Pigs. J Gastrointest Surg 2018; 22:203-213. [PMID: 28766271 DOI: 10.1007/s11605-017-3512-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/12/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces more rapid liver growth than portal vein ligation (PVL). Transection of parenchyma in ALPPS may prevent the formation of collaterals between lobes. The aim of this study was to determine if abrogating the formation of collaterals through parenchymal transection impacted growth rate. METHODS Twelve Yorkshire Landrace pigs were randomized to undergo ALPPS, PVL, or "partial ALPPS" by varying degrees of parenchymal transection. Hepatic volume was measured after 7 days. Portal blood flow and pressure were measured. Portal vein collaterals were examined from epoxy casts. RESULTS PVL, ALPPS, and partial ALPPS led to volume increases of the RLL by 15.5% (range 3-22), 64% (range 45-76), and 32% (range 18-77), respectively, with significant differences between PVL and ALPPS/partial ALPPS (p < 0.05). In PVL and partial ALPPS, substantial new portal vein collaterals were found. The number of collaterals correlated inversely with the growth rate (p = 0.039). Portal vein pressure was elevated in all models after ligation suggesting hyperflow to the portal vein-supplied lobe (p < 0.05). CONCLUSIONS These data suggest that liver hypertrophy following PVL is inversely proportional to the development of collaterals. Hypertrophy after ALPPS is likely more rapid due to reduction of collaterals through transection.
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Affiliation(s)
- Rebecca Deal
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA
| | - Charles Frederiks
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA
| | - Lauren Williams
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA
| | - Pim B Olthof
- Department of Experimental Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Konstantin Dirscherl
- Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland
| | - Xavier Keutgen
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA
| | - Edie Chan
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA
| | - Daniel Deziel
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA
| | - Martin Hertl
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA
| | - Erik Schadde
- Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA. .,Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland. .,Cantonal Hospital Winterthur, Brauerstr. 15, 8401, Winterthur, Kanton Zurich, Switzerland.
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Lang H, Mittler J, Oldhafer KJ, Schadde E, Yamamoto Y. Frontiers of Liver Surgery. Visc Med 2018; 33:463-465. [PMID: 29344521 DOI: 10.1159/000485687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hauke Lang
- Department of General, Visceral, and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Jens Mittler
- Department of General, Visceral, and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Karl J Oldhafer
- Department of General and Visceral Surgery, Surgical Oncology, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis Medical Faculty, Campus Hamburg, Hamburg, Germany
| | - Erik Schadde
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA.,Cantonal Hospital Winterthur, Winterthur, Switzerland.,Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Yuzo Yamamoto
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Labgaa I, Slankamenac K, Schadde E, Jibara G, Alshebeeb K, Mentha G, Clavien PA, Schwartz M. Liver resection for metastases not of colorectal, neuroendocrine, sarcomatous, or ovarian (NCNSO) origin: A multicentric study. Am J Surg 2018; 215:125-130. [DOI: 10.1016/j.amjsurg.2017.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/25/2017] [Accepted: 09/19/2017] [Indexed: 12/24/2022]
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Breitenstein S, Zehnder A, Gelpke H, Soll C, Adamina M, Grieder F, Schadde E, Grochola LF. [Colorectal metastases - Current treatment strategies]. Ther Umsch 2018; 75:634-641. [PMID: 31232665 DOI: 10.1024/0040-5930/a001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Colorectal metastases - Current treatment strategies Abstract. In the course of their disease, more than 50 % of patients with colorectal cancer develop metastases. They are most frequently localized in the liver, followed by the peritoneum and the lungs. The therapeutic options and prognosis of colorectal metastases have improved markedly in recent years. Modern treatment concepts are multimodal and are customized for the individual patient by interdisciplinary tumour boards that follow widely recognised guidelines and norms. The recommendation of an appropriate treatment option in metastasized patients by an interdisciplinary panel of experts is of paramount importance. Besides technical possibilities, factors such as comorbidities, medical outcomes, quality of processes as well as patient-related outcome are all crucial in the decision-making process. In most patients diagnosed with distant metastases, the prognosis is determined by the extent of the liver burden. Hereby, the resection of the liver metastases is of utmost importance to improve the prognosis of a patient, since only those individuals who have successfully undergone resection have a chance for long-term disease free-survival. Whether liver metastases are resectable depends on sufficient volume and function of the future liver remnant (FLR). Manipulation of the FLR as well as upfront oncological treatment of metastases improves the resectability rates in patients with an advanced tumor load in the liver. Laparoscopic liver resection improves patient outcomes by reducing pain and results in a shortened hospital stay. Lung resection for pulmonary metastases as well as cytoreductive surgery for peritoneal metastases are important mainstays of modern personalized treatment concepts. However, results of ongoing trials are eagerly awaited to help quantify the prognostic effects of those therapies and assess their true therapeutic value.
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Affiliation(s)
| | - Adrian Zehnder
- 1 Klinik für Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur
| | - Hans Gelpke
- 1 Klinik für Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur
| | - Christopher Soll
- 1 Klinik für Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur
| | - Michel Adamina
- 1 Klinik für Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur
| | - Felix Grieder
- 1 Klinik für Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur
| | - Erik Schadde
- 1 Klinik für Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur
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Abstract
Background ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was introduced with the promise to reduce posthepatectomy liver failure (PHLF) in extended hepatectomies but has higher morbidity and mortality rates compared to conventional methods of volume enhancement. There are few studies of the incidence of PHLF after ALPPS and little information on how to avoid PHLF by functional testing. It remains unclear what causes the compromise in liver function despite rapid volume gain and if any of the modifications proposed reduce the incidence of PHLF. This review summarizes published data on this topic. Methods This is a systematic review that studies literature on the incidence of liver failure and assessment of liver function following ALPPS as well as modifications of the existing technique. Articles were searched in PubMed, evaluated, selected, and tabulated. Results The literature search revealed 326 articles that met the selection criteria. PHLF criteria as defined by the International Study Group of Liver Surgery (ISGLS) were the most commonly used criteria, but PHLF was frequently not defined. PHLF occurred most frequently after stage 2 of ALPPS at around 30% in most larger studies. Hepatobiliary scintigraphy showed a discrepancy between volume and functional growth of the liver. Function increase was only 50% compared to volume increase. Mechanistic explanations using histologic analyses have been given to explain the immaturity of the liver after rapid hypertrophy. Modifications of ALPPS showed a comparable volumetric gain when compared to classic ALPPS, but data were lacking to assess PHLF. Conclusion ALPPS has relatively high rates of PHLF, morbidity, and mortality. This may be explained by data demonstrating functional growth when compared to volume growth. ALPPS should not be performed without functional assessment and with caution.
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Affiliation(s)
- Danby Kang
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Erik Schadde
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA.,Cantonal Hospital Winterthur, Winterthur, Switzerland.,Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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45
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Enne M, Schadde E, Björnsson B, Hernandez Alejandro R, Steinbruck K, Viana E, Robles Campos R, Malago M, Clavien PA, De Santibanes E, Gayet B. ALPPS as a salvage procedure after insufficient future liver remnant hypertrophy following portal vein occlusion. HPB (Oxford) 2017; 19:1126-1129. [PMID: 28917644 DOI: 10.1016/j.hpb.2017.08.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 05/30/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND A minimum future liver remnant (FLR) of 30% is required to avoid post hepatectomy liver failure (PHLF). Portal vein occlusion (PVO) is the main strategy to induce hypertrophy of the FLR, but some patients will not reach sufficient FLR hypertrophy to enable resection. Recently ALPPS has emerged as a "Salvage Procedure" for PVO failure. The aim of this study was to report the short term outcomes of ALPPS following PVO failure. METHODS A retrospective analysis of patients enrolled within the international ALPPS Registry between October 2012 and November 2015 (NCT01924741) was performed. Patients with documented PVO failure were included. The outcomes reported included feasibility, FLR growth rate and safety of ALPPS. Complications were recorded as per Clavien-Dindo classification. RESULTS From 510 patients enrolled in the Registry there were 22 patients with previous PVO failure. Two patients were excluded due to missing data and twenty patients were analysed. All of them completed the proposed ALPPS with a medium FLR increase of 88% (23-115%) between two stages and no 90-day mortality. CONCLUSION In experienced centers, ALPPS following PVO failure is feasible and safe. The FLR hypertrophy was similar to other ALPPS series. ALPPS is a potential rescue strategy after PVO failure.
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Affiliation(s)
| | - Erik Schadde
- Cantonal Hospital Winterthur, Canton of Zurich, Switzerland; Rush University Medical Center, USA
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46
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Deshayes E, Schadde E, Piron L, Quenet F, Guiu B. Extended Liver Venous Deprivation Leads to a Higher Increase in Liver Function that ALPPS in Early Assessment : A comment to "Sparrelid, E. et al. Dynamic Evaluation of Liver Volume and Function in Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy. Journal of Gastrointestinal Surgery (2017)". J Gastrointest Surg 2017; 21:1754-1755. [PMID: 28785933 DOI: 10.1007/s11605-017-3508-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/11/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Emmanuel Deshayes
- Department of Nuclear Medicine, Institut régional du Cancer de Montpellier (ICM), 208 avenue des Apothicaires, 34298, Montpellier, France. .,INSERM U1194, Montpellier Cancer Research Institute, 34298, Montpellier, France.
| | - Erik Schadde
- Department of Surgery, Cantonal Hospital Winterthur, Canton of Zürich, Switzerland.,Department of Surgery, Abdominal Organ Transplant, Rush University Medical Center, Chicago, Illinois, USA.,Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Lauranne Piron
- Department of Radiology, St-Eloi University Hospital, 34980, Montpellier, France
| | - François Quenet
- Department of Surgery, Institut du Cancer de Montpellier, 34298, Montpellier, France
| | - Boris Guiu
- INSERM U1194, Montpellier Cancer Research Institute, 34298, Montpellier, France.,Department of Radiology, St-Eloi University Hospital, 34980, Montpellier, France
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47
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Chivukula SV, Wang X, Tierney J, Schadde E, Hertl M, Poirier J, Keutgen XM. Removal of Primary Tumor Improves Survival in Metastatic Neuroendocrine Tumors of the Pancreas, Small Intestines, Colon and Rectum: A National Cancer Database Study. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Schadde E, Hertl M, Breitenstein S, Beck-Schimmer B, Schläpfer M. Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure. J Vis Exp 2017. [PMID: 28829432 DOI: 10.3791/55895] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recent clinical data support an aggressive surgical approach to both primary and metastatic liver tumors. For some indications, like colorectal liver metastases, the amount of liver tissue left behind after liver resection has become the main limiting factor of resectability of large or multiple liver tumors. A minimal amount of functional tissue is required to avoid the severe complication of post-hepatectomy liver failure, which has high morbidity and mortality. Inducing liver growth of the prospective remnant prior to resection has become more established in liver surgery, either in the form of portal vein embolization by interventional radiologists or in the form of portal vein ligation several weeks prior to resection. Recently, it was shown that liver regeneration is more extensive and rapid, when the parenchymal transection is added to portal vein ligation in a first stage and then, after only one week of waiting, resection performed in a second stage (Associating Liver Partition and Portal vein ligation for Staged hepatectomy = ALPPS). ALPPS has rapidly become popular across the world, but has been criticized for its high perioperative mortality. The mechanism of accelerated and extensive growth induced by this procedure has not been well understood. Animal models have been developed to explore both the physiological and molecular mechanisms of accelerated liver regeneration in ALPPS. This protocol presents a rat model that allows mechanistic exploration of accelerated regeneration.
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Affiliation(s)
- Erik Schadde
- Institute of Physiology - Center for Integrative Human Physiology, University of Zurich; Department of Surgery, Rush University Medical Center; Department of Surgery, Cantonal Hospital Winterthur;
| | - Martin Hertl
- Department of Surgery, Rush University Medical Center
| | | | - Beatrice Beck-Schimmer
- Institute of Physiology - Center for Integrative Human Physiology, University of Zurich; Institute of Anesthesiology, University and University Hospital Zurich
| | - Martin Schläpfer
- Institute of Physiology - Center for Integrative Human Physiology, University of Zurich; Institute of Anesthesiology, University and University Hospital Zurich
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49
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Olthof PB, Tomassini F, Huespe PE, Truant S, Pruvot FR, Troisi RI, Castro C, Schadde E, Axelsson R, Sparrelid E, Bennink RJ, Adam R, van Gulik TM, de Santibanes E. Hepatobiliary scintigraphy to evaluate liver function in associating liver partition and portal vein ligation for staged hepatectomy: Liver volume overestimates liver function. Surgery 2017; 162:775-783. [PMID: 28732555 DOI: 10.1016/j.surg.2017.05.022] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 05/21/2017] [Accepted: 05/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces a rapid and extensive increase in liver volume. The functional quality of this hypertrophic response has been called into question because ALPPS is associated with a substantial incidence of liver failure and high perioperative mortality. This multicenter study aimed to evaluate functional liver regeneration in contrast to volumetric liver regeneration in ALPPS, using technetium-99m hepatobiliary scintigraphy and computed tomography volumetry, respectively. METHODS Patients who underwent ALPPS and hepatobiliary scintigraphy in 6 centers were included. Hepatobiliary scintigraphy data were analyzed centrally at the Academic Medical Center in Amsterdam according to established protocols. Increase in liver function as measured by hepatobiliary scintigraphy after stage 1 of ALPPS was compared with the increase in liver volume. In addition, we analyzed the impact of liver function and volume on postoperative outcomes including liver failure, morbidity, and mortality. RESULTS In 60 patients, future liver remnant volume increased by a median 78% (interquartile range 48-110) during a median 8 (interquartile range 6-14) days after stage 1, while function as measured by hepatobiliary scintigraphy increased by a median 29% (interquartile range 1-55) throughout 7 days (interquartile range 6-10) in the 27 patients with paired measurements. After stage 2 of ALPPS, liver failure occurred in 5/60 (8%) patients, severe complications in 24/60 (40%), and mortality occurred in 4/60 (7%). CONCLUSION In ALPPS, volumetry overestimates liver function as measured by hepatobiliary scintigraphy and may be responsible for the high rate of liver failure. Quantitative liver function tests are highly recommended to avoid post hepatectomy liver failure.
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Affiliation(s)
- Pim B Olthof
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Federico Tomassini
- Department of General, HPB and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium
| | - Pablo E Huespe
- Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Stephanie Truant
- Department of Digestive Surgery and Transplantation, University of Lille Nord de France, Lille, France
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, University of Lille Nord de France, Lille, France
| | - Roberto I Troisi
- Department of General, HPB and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium
| | - Carlos Castro
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Hôpitaux de Paris Université Paris-Sud, Villejuif, France
| | - Erik Schadde
- Department of Surgery, Division of Transplantation, Rush University Medical Center, Chicago, IL; Cantonal Hospital Winterthur, Kanton Zurich, Switzerland; Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Rimma Axelsson
- Department of Clinical Science, Intervention and Technology, Division of Radiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Roelof J Bennink
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rene Adam
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Hôpitaux de Paris Université Paris-Sud, Villejuif, France
| | - Thomas M van Gulik
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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50
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Eshmuminov D, Tschuor C, Raptis DA, Boss A, Wurnig MC, Sergeant G, Schadde E, Clavien PA. Rapid liver volume increase induced by associating liver partition with portal vein ligation for staged hepatectomy (ALPPS): Is it edema, steatosis, or true proliferation? Surgery 2017; 161:1549-1552. [DOI: 10.1016/j.surg.2017.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/04/2017] [Accepted: 01/11/2017] [Indexed: 01/14/2023]
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