Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
-
J. Gastrointest. Surg. · Sep 2015
Multiple Tumors Located in the Same Section Are Associated with Better Outcomes After Hepatic Resection for HCC Patients Meeting the Milan Criteria.
The impact of the tumor location on the outcome after hepatic resection (HR) in multifocal hepatocellular carcinoma (HCC) is still poorly understood. The aim of this study was to compare the short- and long-term outcomes of HR patients with multifocal tumors meeting the Milan criteria and tumors located in the same or different sections. A total of 219 consecutive HR patients with multifocal tumors meeting the Milan criteria were divided into group SS (n = 97; same section) and group DS (n = 122; different sections) according to their anatomical location (Couinaud's segmentation). ⋯ The subgroup analysis showed that patients with two tumors in the same section and patients undergoing en bloc resection had better OS and RFS. A multivariate analysis revealed that tumors located in different sections and macrovascular invasion were independent predictors of poor prognosis. In HCC patients with multifocal tumors meeting the Milan criteria, tumors located in the same hepatic section may lead to better long-term survival and lower HCC recurrence rates than tumors in different sections after HR.
-
J. Gastrointest. Surg. · Sep 2015
A Simple Method to Evaluate Whether Pancreas Texture Can Be Used to Predict Pancreatic Fistula Risk After Pancreatoduodenectomy.
Soft pancreas is one of the most important risk factor for postoperative pancreatic fistula after pancreatoduodenectomy. The aim of this study is to investigate whether pancreatic attenuation index utilized to assess the pancreatic texture with computed tomography can be used to predict the risk of developing a clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy. ⋯ A preoperative non-contrast computed tomography scan evaluating pancreatic attenuation index could help to predict the occurrence of clinically significant postoperative pancreatic fistula after pancreatoduodenectomy.
-
J. Gastrointest. Surg. · Sep 2015
Trends in Hospital Volume and Failure to Rescue for Pancreatic Surgery.
We sought to evaluate trends in selection of high volume (HV) hospitals for pancreatic surgery, as well as examine trends in preoperative complications, mortality, and failure to rescue (FTR). ⋯ Median hospital volume for pancreatic surgery has increased over the past decade. While the morbidity remained relatively stable over time, mortality improved especially in LV and IV hospitals. This improvement in mortality seems to be related to a decreased FTR.
-
J. Gastrointest. Surg. · Sep 2015
Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis.
We sought to estimate the cost-effectiveness of hepatic resection (HR) (strategy A) relative to surveillance plus 6 months of additional systemic chemotherapy (sCT) (strategy B) for patients with colorectal disappearing liver metastases (DLM). ⋯ Surveillance of DLM after sCT was more beneficial and cost-effective among patients >60 years with multiple factors predictive of true complete pathological response, such as normalization of CEA, HAI therapy, BMI ≤30 kg/m(2), and diagnosis of DLM made through MRI.