Surgery
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Blood transfusion is recommended to prevent the harmful effects of tissue hypoxia. Whether transfusion alleviates hypoxia at the microcirculatory level is unknown. The objective of this study was to determine whether the effects of fresh blood transfusion on microcirculatory hemodynamics after blood loss are preferable to the effects of banked blood transfusion. ⋯ Fresh blood transfusion is more effective in relieving effects of microcirculatory hypoxia. Banked blood, in particular 2-week stored blood, has limited capacity of improving tissue oxygenation.
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It is still not clear how combined vascular resection affects the outcome of patients with hilar cholangiocarcinoma. Our aim was to evaluate implications of combined vascular resection in patients with hilar cholangiocarcinoma by analyzing the outcomes of all patients who underwent operative resection. ⋯ Although both portal vein and hepatic artery resection are independent poor prognostic factors after curative operative resection of locally advanced hilar cholangiocarcinoma, portal vein resection is acceptable from an operative risk perspective and might improve the prognosis in the selected patients, however, combined hepatic artery resection can not be justified.