Journal of the American College of Surgeons
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Orthotopic liver transplantation (OLT) is the accepted treatment in patients with unresectable, early-stage hepatocellular carcinoma (HCC) in the setting of cirrhosis. Due to increasing waitlist demand for OLT, determining optimal groups for transplant is critical. Elderly patients are known to have poorer postoperative outcomes. Considering the effectiveness of liver-directed therapies for HCC, we sought to determine whether elderly patients received survival benefit from OLT over liver-directed therapy alone. ⋯ Despite increased age and associated comorbidities being factors associated with poor outcomes, OLT confers a survival advantage compared to liver-directed ablative therapies alone in selected elderly patients with HCC. OLT should be offered in medically appropriate elderly patients with HCC.
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The influence of laparoscopic ultrasonography (LUS) on the operative management of patients during laparoscopic cholecystectomy (LC) has not been examined in a large unselected series. ⋯ The primary value of LUS during LC is for anatomic identification when there are severe local inflammatory conditions. In this setting, LUS imaging can facilitate safe completion of LC or an early decision for an alternate operative strategy. When performed primarily for common bile duct stones or as routine practice, LUS results in CBDE for a limited proportion of patients.