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| 1 | Minimally invasive liver resection for huge(≥10cm)tumors:an international multicenter matched cohort study with regression discontinuity analyses显示文摘Background:The application and feasibility of minimally invasive liver resection(MILR)for huge liver tumours(≥10 cm)has not been well documented.Methods:Retrospective analysis of data on 6,617 patients who had MILR for liver tumours were gathered from 21 international centers between 2009-2019.Huge tumors and large tumors were defined as tumors with a size≥10.0 cm and 3.0-9.9 cm based on histology,respectively.1:1 coarsened exact-matching(CEM)and 1:2 Mahalanobis distance-matching(MDM)was performed according to clinically-selected variables.Regression discontinuity analyses were performed as an additional line of sensitivity analysis to estimate local treatment effects at the 10-cm tumor size cutoff.Results:Of 2,890 patients with tumours≥3 cm,there were 205 huge tumors.After 1:1 CEM,174 huge tumors were matched to 174 large tumors;and after 1:2 MDM,190 huge tumours were matched to 380 large tumours.There was significantly and consistently increased intraoperative blood loss,frequency in the application of Pringle maneuver,major morbidity and postoperative stay in the huge tumour group compared to the large tumour group after both 1:1 CEM and 1:2 MDM.These findings were reinforced in RD analyses.Intraoperative blood transfusion rate and open conversion rate were significantly higher in the huge tumor group after only 1:2 MDM but not 1:1 CEM.Conclusions:MILR for huge tumours can be safely performed in expert centers It is an operation with substantial complexity and high technical requirement,with worse perioperative outcomes compared to MILR for large tumors,therefore judicious patient selection is pivotal. | Tan-To Cheung Xiaoying Wang Mikhail Efanov Rong Liu David Fuks Gi-Hong Choi Nicholas LSyn Charing CChong Iswanto Sucandy Adrian KHChiow Marco VMarino Mikel Gastaca Jae Hoon Lee TPeter Kingham Mathieu D’Hondt Sung Hoon Choi Robert PSutcliffe Ho-Seong Han Chung Ngai Tang Johann Pratschke Roberto ITroisi Brian KPGoh International Robotic and Laparoscopic Liver Resection Study Group Collaborators | 2021 | Hepatobiliary Surgery and Nutrition2021，10，5： | 1 |
| 2 | Early tacrolimus exposure does not impact long-term outcomes after liver transplantation显示文摘BACKGROUND Tacrolimus trough levels(TTL)during the first weeks after liver transplantation(LT)have been related with long-term renal function and hepatocellular carcinoma recurrence.Nevertheless,the significance of trough levels of tacrolimus during the early post-transplant period for the long-term outcome is under debate AIM To evaluate the effect of TTL during the first month on the long-term outcomes after LT.METHODS One hundred fifty-five LT recipients treated de novo with once-daily tacrolimus were retrospectively studied.Patients with repeated LT or combined transplantation were excluded as well as those who presented renal dysfunction prior to transplantation and/or those who needed induction therapy.Patients were classified into 2 groups according to their mean TTL within the first month after transplantation:≤10(n=98)and>10 ng/mL(n=57).Multivariate analyses were performed to assess risk factors for patient mortality.RESULTS Mean levels within the first month post-transplant were 7.4±1.7 and 12.6±2.2 ng/mL in the≤10 and>10 groups,respectively.Donor age was higher in the high TTL group 62.9±16.8 years vs 45.7±17.5 years(P=0.002)whilst mycophenolate-mofetil was more frequently used in the low TTL group 32.7%vs 15.8%(P=0.02).Recipient features were generally similar across groups.After a median follow-up of 52.8 mo(range 2.8-81.1),no significant differences were observed in:Mean estimated glomerular filtration rate(P=0.69),hepatocellular carcinoma recurrence(P=0.44),de novo tumors(P=0.77),new-onset diabetes(P=0.13),or biopsy-proven acute rejection rate(12.2%and 8.8%,respectively;P=0.50).Eighteen patients died during the follow-up and were evenly distributed across groups(P=0.83).Five-year patient survival was 90.5%and 84.9%,respectively(P=0.44),while 5-year graft survival was 88.2%and 80.8%,respectively(P=0.42).Early TTL was not an independent factor for patient mortality in multivariate analyses.CONCLUSION Differences in tacrolimus levels restricted to the first month after transplant did not result in significant differences in long-term outcomes of LT recipients. | Mikel Gastaca Patricia Ruiz Javier Bustamante Lorea Martinez-Indart Alberto Ventoso JoséRamón Fernandez Ibone Palomares Mikel Prieto Milagros Testillano Patricia Salvador Maria Senosiain Maria Jesus Suárez Andres Valdivieso | 2021 | World Journal of Hepatology2021，13，3： | 0 |
| 3 | Endovascular treatment for early hepatic artery occlusion after liver transplantation: Angioplasty or stent显示文摘To the Editor:We read with great interest the recent article by Zhu et al.[1].In the study,the authors analyzed the outcomes of 26 patients diagnosed with hepatic artery occlusion(HAO)and treated with an endovascular approach(EVT)within the first 30 days after ortho-topic liver transplantation(LT).The median interval from LT to EVT was 7 days,most patients were treated with angioplasty and only two(7.7%)needed stent placement.The authors should be congrat-ulated as they achieved a 100%of success rate with an 80.8%of 1-year survival rate. | Mikel Gastaca Javier Gomez Ignacio Terreros | 2022 | Hepatobiliary & Pancreatic Diseases International2022，21，6： | 0 |
| 4 | Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases显示文摘Background:The use of laparoscopic(LLR)and robotic liver resections(RLR)has been safely performed in many institutions for liver tumours.A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours≥10 cm.Methods:This was a retrospective review of 971 patients who underwent LLR and RLR for huge(≥10 cm)tumors at 42 international centers between 2002-2020.Results:One hundred RLR and 699 LLR which met study criteria were included.The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching(PSM)(73 vs.219).Before PSM,LLR was associated with significantly increased frequency of previous abdominal surgery,malignant pathology,liver cirrhosis and increased median blood.After PSM,RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time(242 vs.290 min,P=0.286),transfusion rate rate(19.2%vs.16.9%,P=0.652),median blood loss(200 vs.300 mL,P=0.694),open conversion rate(8.2%vs.11.0%,P=0.519),morbidity(28.8%vs.21.9%,P=0.221),major morbidity(4.1%vs.9.6%,P=0.152),mortality and postoperative length of stay(6 vs.6 days,P=0.435).Conclusions:RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes.There was no significant difference in perioperative outcomes after RLR or LLR. | Tan-To Cheung Rong Liu Federica Cipriani Xiaoying Wang Mikhail Efanov David Fuks Gi-Hong Choi Nicholas L.Syn Charing C.N.Chong Fabrizio Di Benedetto Ricardo Robles-Campos Vincenzo Mazzaferro Fernando Rotellar Santiago Lopez-Ben James O.Park Alejandro Mejia Iswanto Sucandy Adrian K.H.Chiow Marco V.Marino Mikel Gastaca Jae Hoon Lee TPeter Kingham Mathieu D’Hondt Sung Hoon Choi Robert P.Sutcliffe Ho-Seong Han Chung-Ngai Tang Johann Pratschke Roberto I.Troisi Go Wakabayashi Daniel Cherqui Felice Giuliante Davit L.Aghayan Bjorn Edwin Olivier Scatton Atsushi Sugioka Tran Cong Duy Long Constantino Fondevila Mohammad Abu Hilal Andrea Ruzzenente Alessandro Ferrero Paulo Herman Kuo-Hsin Chen Luca Aldrighetti Brian K.P.Goh International robotic and laparoscopic liver resection study group investigators | 2023 | Hepatobiliary Surgery and Nutrition2023，12，2： | 0 |
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