Background: Post-hepatectomy liver failure(PHLF) is a leading cause of postoperative mortality after liver surgery. Due to its significant impact, it is imperative to understand the risk stratification and preventativ...Background: Post-hepatectomy liver failure(PHLF) is a leading cause of postoperative mortality after liver surgery. Due to its significant impact, it is imperative to understand the risk stratification and preventative strategies for PHLF. The main objective of this review is to highlight the role of these strategies in a timeline centered way around curative resection. Data sources: This review includes studies on both humans and animals, where they addressed PHLF. A literature search was conducted across the Cochrane Library, Embase, MEDLINE/Pub Med, and Web of Knowledge electronic databases for English language studies published between July 1997 and June 2020. Studies presented in other languages were equally considered. The quality of included publications was assessed using Downs and Black’s checklist. The results were presented in qualitative summaries owing to the lack of studies qualifying for quantitative analysis. Results: This systematic review with 245 studies, provides insight into the current prediction, prevention, diagnosis, and management options for PHLF. This review highlighted that liver volume manipulation is the most frequently studied preventive measure against PHLF in clinical practice, with modest improvement in the treatment strategies over the past decade. Conclusions: Remnant liver volume manipulation is the most consistent preventive measure against PHLF.展开更多
Background:Obesity is associated with increased oncological risk and outcomes but the evidence surrounding the effect of body mass index(BMI)on increased risk of hepatocellular carcinoma(HCC)recurrence after liver tra...Background:Obesity is associated with increased oncological risk and outcomes but the evidence surrounding the effect of body mass index(BMI)on increased risk of hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)is still questionable.The purpose of this retrospective study of a large cohort of adult patients transplanted for HCC was to investigate the effect of BMI on the incidence of HCC recurrence and outcome.Methods:Data from 427 adult recipients transplanted for HCC between 2000 and 2017 were collected.Patients were classified at time of LT according to the World Health Organization BMI classification into 3 groups;group 1:BMI<25(n=166),group 2:BMI 25-29.9(n=150)and group 3:BMI≥30(n=111).Results:There were no significant changes of mean BMI overtime 26.8±5.0 kg/m2 at time of LT and 28.8±23.1 at 5 years.The recurrence rates of HCC after LT in the three groups were 19%,16%and 17%respectively.The 5,10 and 15-year recurrence free survival(RFS)rates were respectively 68.6%,47.3%and 40.8%in group 1,73.3%,66.2%and 49.5%in group 2 and 68.8%,57.5%and 47.7%in group 3(log rank P=0.47).Conclusions:Recipient BMI at time of transplant and during follow-up didn’t impact the incidence of HCC recurrence nor long-term patient survival,irrespective to the status of the patients and their tumor characteristic at time of LT.The present study clearly confirms that obesity should not be considered,when selecting patients with HCC to LT,as a predictive factor of recurrence.展开更多
Background: The hepatic hemodynamics is an essential parameter in surgical planning as well as in various disease processes. The transit time ultrasound(TTUS) perivascular flow probe technology is widely used in clini...Background: The hepatic hemodynamics is an essential parameter in surgical planning as well as in various disease processes. The transit time ultrasound(TTUS) perivascular flow probe technology is widely used in clinical practice to evaluate the hepatic inflow, yet invasive. The phase-contrast-MRI(PC-MRI) is not invasive and potentially applicable in assessing the hepatic blood flow. In the present study, we compared the hepatic inflow rates using the PC-MRI and the TTUS probe, and evaluated their predictive value of post-hepatectomy adverse events. Methods: Eighteen large white pigs were anaesthetized for PC-MRI and approximately 75% hepatic resection was performed under a unified protocol. The blood flow was measured in the hepatic artery(Qha), the portal vein(Qpv), and the aorta above the celiac trunk(Qca) using PC-MRI, and was compared to the TTUS probe. The Bland-Altman method was conducted and a partial least squares regression(PLS) model was implemented. Results: The mean Qpv measured in PC-MRI was 0.55 ± 0.12 L/min, and in the TTUS probe was 0.74 ± 0.17 L/min. Qca was 1.40 ± 0.47 L/min in the PC-MRI and 2.00 ± 0.60 L/min in the TTUS probe. Qha was 0.17 ± 0.10 L/min in the PC-MRI, and 0.13 ± 0.06 L/min in the TTUS probe. The Bland-Altman method revealed that the estimated bias of Qca in the PC-MRI was 32%(95% CI:-49% to 15%); Qha 17%(95% CI:-15% to 51%); and Qpv 40%(95% CI:-62% to 18%). The TTUS probe had a higher weight in predicting adverse outcomes after 75% resection compared to the PC-MRI( β= 0.35 and 0.43 vs β = 0.22 and 0.07, for tissue changes and premature death, respectively). Conclusions: There is a tendency of the PC-MRI to underestimate the flow measured by the TTUS probes. The TTUS probe measures are more predictive of relevant post-hepatectomy outcomes.展开更多
We describe a case of late post-traumatic diaphragmatic hernia revealed during pregnancy by bowel obstruction. The diagnosis was made during exploratory laparotomy at 29 weeks. After surgical repair of the hernia the ...We describe a case of late post-traumatic diaphragmatic hernia revealed during pregnancy by bowel obstruction. The diagnosis was made during exploratory laparotomy at 29 weeks. After surgical repair of the hernia the pregnancy went to term uneventfully. A healthy baby was delivered at 39 weeks by elective cesarean section.展开更多
文摘Background: Post-hepatectomy liver failure(PHLF) is a leading cause of postoperative mortality after liver surgery. Due to its significant impact, it is imperative to understand the risk stratification and preventative strategies for PHLF. The main objective of this review is to highlight the role of these strategies in a timeline centered way around curative resection. Data sources: This review includes studies on both humans and animals, where they addressed PHLF. A literature search was conducted across the Cochrane Library, Embase, MEDLINE/Pub Med, and Web of Knowledge electronic databases for English language studies published between July 1997 and June 2020. Studies presented in other languages were equally considered. The quality of included publications was assessed using Downs and Black’s checklist. The results were presented in qualitative summaries owing to the lack of studies qualifying for quantitative analysis. Results: This systematic review with 245 studies, provides insight into the current prediction, prevention, diagnosis, and management options for PHLF. This review highlighted that liver volume manipulation is the most frequently studied preventive measure against PHLF in clinical practice, with modest improvement in the treatment strategies over the past decade. Conclusions: Remnant liver volume manipulation is the most consistent preventive measure against PHLF.
文摘Background:Obesity is associated with increased oncological risk and outcomes but the evidence surrounding the effect of body mass index(BMI)on increased risk of hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)is still questionable.The purpose of this retrospective study of a large cohort of adult patients transplanted for HCC was to investigate the effect of BMI on the incidence of HCC recurrence and outcome.Methods:Data from 427 adult recipients transplanted for HCC between 2000 and 2017 were collected.Patients were classified at time of LT according to the World Health Organization BMI classification into 3 groups;group 1:BMI<25(n=166),group 2:BMI 25-29.9(n=150)and group 3:BMI≥30(n=111).Results:There were no significant changes of mean BMI overtime 26.8±5.0 kg/m2 at time of LT and 28.8±23.1 at 5 years.The recurrence rates of HCC after LT in the three groups were 19%,16%and 17%respectively.The 5,10 and 15-year recurrence free survival(RFS)rates were respectively 68.6%,47.3%and 40.8%in group 1,73.3%,66.2%and 49.5%in group 2 and 68.8%,57.5%and 47.7%in group 3(log rank P=0.47).Conclusions:Recipient BMI at time of transplant and during follow-up didn’t impact the incidence of HCC recurrence nor long-term patient survival,irrespective to the status of the patients and their tumor characteristic at time of LT.The present study clearly confirms that obesity should not be considered,when selecting patients with HCC to LT,as a predictive factor of recurrence.
基金supported mainly by the “Agence de la Biomedecine” through its program of Research(AOR 2009)BM,AC,BP,WM,VCI and VE acknowledged funding of project ANR-13-TECS-0006 by the Agence Nationale de la Recherche
文摘Background: The hepatic hemodynamics is an essential parameter in surgical planning as well as in various disease processes. The transit time ultrasound(TTUS) perivascular flow probe technology is widely used in clinical practice to evaluate the hepatic inflow, yet invasive. The phase-contrast-MRI(PC-MRI) is not invasive and potentially applicable in assessing the hepatic blood flow. In the present study, we compared the hepatic inflow rates using the PC-MRI and the TTUS probe, and evaluated their predictive value of post-hepatectomy adverse events. Methods: Eighteen large white pigs were anaesthetized for PC-MRI and approximately 75% hepatic resection was performed under a unified protocol. The blood flow was measured in the hepatic artery(Qha), the portal vein(Qpv), and the aorta above the celiac trunk(Qca) using PC-MRI, and was compared to the TTUS probe. The Bland-Altman method was conducted and a partial least squares regression(PLS) model was implemented. Results: The mean Qpv measured in PC-MRI was 0.55 ± 0.12 L/min, and in the TTUS probe was 0.74 ± 0.17 L/min. Qca was 1.40 ± 0.47 L/min in the PC-MRI and 2.00 ± 0.60 L/min in the TTUS probe. Qha was 0.17 ± 0.10 L/min in the PC-MRI, and 0.13 ± 0.06 L/min in the TTUS probe. The Bland-Altman method revealed that the estimated bias of Qca in the PC-MRI was 32%(95% CI:-49% to 15%); Qha 17%(95% CI:-15% to 51%); and Qpv 40%(95% CI:-62% to 18%). The TTUS probe had a higher weight in predicting adverse outcomes after 75% resection compared to the PC-MRI( β= 0.35 and 0.43 vs β = 0.22 and 0.07, for tissue changes and premature death, respectively). Conclusions: There is a tendency of the PC-MRI to underestimate the flow measured by the TTUS probes. The TTUS probe measures are more predictive of relevant post-hepatectomy outcomes.
文摘We describe a case of late post-traumatic diaphragmatic hernia revealed during pregnancy by bowel obstruction. The diagnosis was made during exploratory laparotomy at 29 weeks. After surgical repair of the hernia the pregnancy went to term uneventfully. A healthy baby was delivered at 39 weeks by elective cesarean section.
