1,721,094 research outputs found
Effects of volume on outcome in hepatobiliary surgery: a review with guidelines proposal
No full text: The positive relationship between volume and outcome in hepatobiliary surgery has been demonstrated for many years. As for other complex surgical procedures, both improved short- and long-term outcomes have been associated with a higher volume of procedures. However, whether the centralization of complex hepatobiliary procedures makes full sense because it should be associated with higher quality of care, as reported in the literature, precise criteria on what to centralize, where to centralize, and who should be entitled to perform complex procedures are still missing. Indeed, despite the generalized consensus on centralization in hepatobiliary surgery, this topic remains very complex because many determinants are involved in such a centralization process, of which some of them cannot be easily controlled. In the context of different health systems worldwide, such as national health systems and private insurance, there are different stakeholders that demand different needs: politicians, patients, surgeons, institutions and medical associations do not always have the same needs. Starting from a review of the literature on centralization in hepatobiliary surgery, we will propose some guidelines that, while not data-driven due to low evidence in the literature, will be based on good clinical practice
Unravel hepatic artery infusion chemotherapy in patients with resected colorectal liver metastases
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Hepatic resection for hepatocellular carcinoma in cirrhosis
No full textHepatocellular carcinoma is one of the most common cancers worldwide. Several treatment modalities have been proposed, but hepatic resection is still considered the first-line therapeutic option for most of the patient carries of HCC. The proper selection of patients candidate to hepatic resection for HCC and the eradication whenever is possible of the intrahepatic metastases are the most crucial steps for improving the surgical outcome in HCC. This article reviews the current state of the art of the surgical treatment of HCC
COVID-19: emerging challenges for oncological surgery
No full text: After the initial description of COVID-19 in Wuhan, China, Italy was hit first in Europe and the impact has been rapidly enlarging. In early April 2020, at the epidemic peak, there were more than 33,000 patients hospitalized including more than 4,000 in Intensive Care Units (ICU). On May 15, the confirmed cases in Italy approached 224,000 patients (5th highest number worldwide), with more than 31,000 deaths (3rd highest number worldwide). Non-urgent, non-cancer procedures were stopped to reallocate nurses and anesthetists to face the COVID-19 emergency. The timeline of the progressive involvement by COVID-19 patients of 36 hospitals referrals for surgical oncology in Italy was shown in this article. Only emergency, and elective oncological procedures were allowed with obvious limitations in terms of numbers of operable cases. Criteria for prioritizing oncologic patients waiting for surgery were released by each region, mainly issuing main factors for decision making, biological aggressiveness or symptomatic disease, the interval from the latest treatment, and the risk of un-resectability if delayed. However, the lack of facilities mostly influenced the decision or not to proceed. The risk of operating on oncological patients with ongoing SARS-CoV-2 syndrome is real, and a preoperative flowchart for ruling out this occurrence has been promoted. In our center, the day before surgery, chest CT and swab testing have been introduced, and a similar behavior has been recommended prior to patients' discharge. The care of patients addressed for surgical oncology should be featured by dedicated paths to secure proper and prompt disease management
Reflections and perspectives on adjuvant treatment in the setting of resected hepatocellular carcinoma
No full textHepatectomy is a curative procedure in selected patients affected by hepatocellular carcinoma (HCC). However, recurrence rates are as high as 70% five years after resection, and having a valid postoperative systemic regimen would represent a significant improvement in the care of HCC patients. While burgeoning evidence is emerging around the use of immunotherapy in the setting of resected HCC, little is yet known to allow the widespread use of immunotherapy after surgery. Here, we pointed out some reflections and perspectives on adjuvant strategies for patients with resected HCC and discussed potential benefits and drawbacks
Intraoperative ultrasound in patients with hepatocellular carcinoma: from daily practice to future trends
No full textStarting from the end of the 1970s, intraoperative ultrasound was introduced and developed to stage liver disease and guide the surgical interventions in patients with hepatocellular carcinoma. Without intraoperative ultrasound, it would probably be impossible to correctly define the hepatic segments as well as the limits of a tumor, also because of the existing wide variations in the anatomy. More importantly, intraoperative ultrasound allows for three-dimensional reconstruction of the relationships between the tumor, hepatic veins, and Glissonian pedicles. Such reconstruction is essential for planning the surgical strategy, which should be individualized in each patient with the aim to spare functional liver parenchyma. This work focuses on the role of intraoperative ultrasound to stage liver disease and to plan surgical resection, describing the most recent technical achievements
6,126 hepatectomies in 2022: current trend of outcome in Italy
Full text linkPurpose Whether hospital volume affects outcome of patients undergoing hepatobiliary surgery, and whether the centralization of such procedures is justified remains to be investigated. The aim of this study was to analyze the outcome of liver surgery in Italy in relationship of hospital volume. Methods This is a nationwide retrospective observational study conducted on data collected by the National Italian Registry "Piano Nazionale Esiti" (PNE) 2023 that included all liver procedures performed in 2022. Outcome measure were case volume and 30-day mortality. Hospitals were classified as very high-volume (H-Vol), intermediate-volume (I-Vol), low-volume (L-Vol) and very low-volume (VL-VoL). A review on centralization process and outcome measures was added. Results 6,126 liver resections for liver tumors were performed in 327 hospitals in 2022. The 30-day mortality was 2.2%. There were 14 H-Vol, 19 I-Vol, 31 L-Vol and 263 VL-Vol hospitals with 30-day mortality of 1.7%, 2.2%, 2.6% and 3.6% respectively (P < 0.001); 220 centers (83%) performed less than 10 resections, and 78 (29%) centers only 1 resection in 2022. By considering the geographical macro-areas, the median count of liver resection performed in northern Italy exceeded those in central and southern Italy (57% vs. 23% vs. 20%, respectively). Conclusions High-volume has been confirmed to be associated to better outcome after hepatobiliary surgical procedures. Further studies are required to detail the factors associated with mortality. The centralization process should be redesigned and oversight
Are Tumor Exposure and Anatomical Resection Antithetical during Surgery for Hepatocellular Carcinoma? A Critical Review
No full textTailoring the area of hepatic resection using inflow and outflow modulation
No full textThe performance of hepatic surgery without a parenchyma-sparing strategy carries significant risks for patient survival because of the not negligible occurrence of postoperative liver failure. The key factor of modern hepatic surgery is the use of the intraoperative ultrasound (IOUS), not only to stage the disease, but more importantly to guide resection with the specific aim to maximize the sparing of the functional parenchyma. Whether in patients with hepatocellular carcinoma and underlying liver cirrhosis, or in patients with colorectal liver metastasis, IOUS allows the performance of the so-called "radical but conservative surgery", which is the pivotal factor to offer a chance of cure to an increasing proportion of patients, who until few years ago were considered only for palliative care. Using some new IOUS-guided surgical maneuvers, which are based on the liver inflow and outflow modulations, more precise anatomically subsegmental- and segmental-oriented resections can be effectively performed. The present work describes the rationale and the surgical technique for a precise tailoring of the area of hepatic resection using the most recent attainments in IOUS. Such important technical achievements should be a fundamental part of the surgical armamentarium of the modern liver surgeon. (C) 2013 Baishideng. All rights reserved
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