Background The value of artificial colloids in treating patients with liver disease is controversial. The effects of intravascular volume replacement regimens on liver function secondary to alteration of the postopera...Background The value of artificial colloids in treating patients with liver disease is controversial. The effects of intravascular volume replacement regimens on liver function secondary to alteration of the postoperative inflammatory response are not known. In this study, we evaluated the effects of different volume replacement regimens in hepatocellular carcinoma patients undergoing hepatectomy to clarify whether albumin administration can be replaced by other volume replacement products.Methods Ninety consecutive hepatocellular carcinoma patients scheduled for hepatectomy were prospectively randomized to receive 20% human albumin （HA）, 6% hydroxyethyl starch （HES） or lactated Ringer＇s solution （LR） for postoperative volume replacement. Hemodynamic, liver function and inflammatory response parameters were recorded on postoperative days one, three, and five throughout the investigation period.Results Significantly less volume was required in the HA and the HES groups. Although patients in all groups had similar baseline values, the plasma osmolality was significantly higher in the HA and HES groups. Total bilirubin （TB）, alanine aminotransferase （ALT）, and aspartate aminotransferase （AST） increased from baseline in all groups, and did not differ significantly between groups. C-reactive protein （CRP） was significantly lower in the HES group compared with the other groups.Conclusions In hepatocellular carcinoma patients undergoing hepatectomy, HA can be replaced by HES or LR in well selected patients. Hemodynamic stability, liver function, and postoperative clinical outcomes could be equivalently achieved in the HES group; also, HES may exert more favorable effects on the acute phase response. （Registered in the Chinese Clinical Trial Registry, ChiCTR-TRC-10000790）展开更多
Gallbladder cancer(GBC)is a rare malignancy worldwide,with 140,000 new patients each year and more than 100,000 deaths annually.The review aims to address the controversial aspects of managing GBC.Regional differences...Gallbladder cancer(GBC)is a rare malignancy worldwide,with 140,000 new patients each year and more than 100,000 deaths annually.The review aims to address the controversial aspects of managing GBC.Regional differences of the study worldwide remain pending,and comparative mutational profiles will provide more information on the pathogenesis of GBC.However,certain pathologic aspects are discussed,such as the staging of early GBC,outcome differences between T2 pathologically staged patients,and the necessity of a uni-form pathologic report.The surgical management of GBC is still under debate.The extent of liver resection,type of lymphadenectomy,and selection of patients for extended resection are aspects of the disease that require revision.Laparoscopic and robotic approaches were initially slow to develop.However,with time,they have demonstrated their value in the surgical management of GBC.The OMEGA survey,performed to analyze the management practice of surgical treatment of GBC worldwide,demonstrated differences from the recom-mended guidelines.The OMEGA study,the largest cohort study,examined the outcomes of surgical intervention in 3676 patients from 133 centers.Regarding future directions,the value of collaborative efforts between centers and regions must be emphasized to better un-derstand the different aspects of the disease and globally improve therapeutic strategies for GBC.展开更多
Management of patients with synchronous colorectal liver metastases(SCRLM)has transformed dramatically over the past 2 decades(1-3).A step-by-step,patient tailored approach as orchestrated by a multidisciplinary tumor...Management of patients with synchronous colorectal liver metastases(SCRLM)has transformed dramatically over the past 2 decades(1-3).A step-by-step,patient tailored approach as orchestrated by a multidisciplinary tumor board(MDT),combined with advances in surgical techniques,perioperative care and the evolution of systemic therapies have led to remarkable long-term outcomes(2,4).In particular,selected patients with resectable SCRLM undergoing surgery have been reported to enjoy 5-year survival rates as high as 76%(1).However,the optimal surgical strategy for these patients remains elusive with multiple retrospective studies presenting conflicting outcomes(4).In their up-to-date review of the literature Lillemoe and Vauthey sought to evaluate and critically appraise currently available surgical treatment strategies for patients presenting with SCRLM.展开更多
文摘Background The value of artificial colloids in treating patients with liver disease is controversial. The effects of intravascular volume replacement regimens on liver function secondary to alteration of the postoperative inflammatory response are not known. In this study, we evaluated the effects of different volume replacement regimens in hepatocellular carcinoma patients undergoing hepatectomy to clarify whether albumin administration can be replaced by other volume replacement products.Methods Ninety consecutive hepatocellular carcinoma patients scheduled for hepatectomy were prospectively randomized to receive 20% human albumin （HA）, 6% hydroxyethyl starch （HES） or lactated Ringer＇s solution （LR） for postoperative volume replacement. Hemodynamic, liver function and inflammatory response parameters were recorded on postoperative days one, three, and five throughout the investigation period.Results Significantly less volume was required in the HA and the HES groups. Although patients in all groups had similar baseline values, the plasma osmolality was significantly higher in the HA and HES groups. Total bilirubin （TB）, alanine aminotransferase （ALT）, and aspartate aminotransferase （AST） increased from baseline in all groups, and did not differ significantly between groups. C-reactive protein （CRP） was significantly lower in the HES group compared with the other groups.Conclusions In hepatocellular carcinoma patients undergoing hepatectomy, HA can be replaced by HES or LR in well selected patients. Hemodynamic stability, liver function, and postoperative clinical outcomes could be equivalently achieved in the HES group; also, HES may exert more favorable effects on the acute phase response. （Registered in the Chinese Clinical Trial Registry, ChiCTR-TRC-10000790）
文摘Gallbladder cancer(GBC)is a rare malignancy worldwide,with 140,000 new patients each year and more than 100,000 deaths annually.The review aims to address the controversial aspects of managing GBC.Regional differences of the study worldwide remain pending,and comparative mutational profiles will provide more information on the pathogenesis of GBC.However,certain pathologic aspects are discussed,such as the staging of early GBC,outcome differences between T2 pathologically staged patients,and the necessity of a uni-form pathologic report.The surgical management of GBC is still under debate.The extent of liver resection,type of lymphadenectomy,and selection of patients for extended resection are aspects of the disease that require revision.Laparoscopic and robotic approaches were initially slow to develop.However,with time,they have demonstrated their value in the surgical management of GBC.The OMEGA survey,performed to analyze the management practice of surgical treatment of GBC worldwide,demonstrated differences from the recom-mended guidelines.The OMEGA study,the largest cohort study,examined the outcomes of surgical intervention in 3676 patients from 133 centers.Regarding future directions,the value of collaborative efforts between centers and regions must be emphasized to better un-derstand the different aspects of the disease and globally improve therapeutic strategies for GBC.
文摘Management of patients with synchronous colorectal liver metastases(SCRLM)has transformed dramatically over the past 2 decades(1-3).A step-by-step,patient tailored approach as orchestrated by a multidisciplinary tumor board(MDT),combined with advances in surgical techniques,perioperative care and the evolution of systemic therapies have led to remarkable long-term outcomes(2,4).In particular,selected patients with resectable SCRLM undergoing surgery have been reported to enjoy 5-year survival rates as high as 76%(1).However,the optimal surgical strategy for these patients remains elusive with multiple retrospective studies presenting conflicting outcomes(4).In their up-to-date review of the literature Lillemoe and Vauthey sought to evaluate and critically appraise currently available surgical treatment strategies for patients presenting with SCRLM.
