HPB : the official journal of the International Hepato Pancreato Biliary Association
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Comparative Study
A 21-year analysis of stage I gallbladder carcinoma: is cholecystectomy alone adequate?
Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival. ⋯ In the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered.
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Both laparoscopic techniques and multimodal enhanced recovery programmes have been shown to improve recovery and reduce length of hospital stay. Interestingly, evidence-based care programmes are not widely implemented, whereas new, minimally invasive surgical procedures are often adopted with very little evidence to support their effectiveness. The present survey aimed to shed light on experiences of the adoption of both methods of optimizing recovery. ⋯ Worldwide dissemination of laparoscopic liver resection is substantial, although laparoscopic volumes are low in the majority of HPB centres. The adoption of enhanced recovery programmes in liver surgery is limited and should be given greater attention.
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Comparative Study
Does pharmacological conditioning with the volatile anaesthetic sevoflurane offer protection in liver surgery?
A recently published randomized control trial (RCT) showed a protection of the remnant liver from ischemia-reperfusion (I/R) injury by pharmacological pre-conditioning with a volatile anaesthetic in patients undergoing hepatic resection. Whether the continuous application of volatile anaesthetics (pharmacological conditioning) also protects against I/R injury is unknown. ⋯ In this retrospective study, continuous volatile anaesthesia in liver resection does not provide protection of the remnant liver from IR injury compared with continuous i.v. anaesthesia.
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Review Meta Analysis
Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review.
The aim of this meta-analysis was to analyse the outcomes of major pancreatic surgery among the elderly (≥75 and ≥80 years of age). ⋯ There is an increased incidence of post-operative mortality and pneumonia after a PD among all elderly patients ≥75 years of age, as well as an increased incidence of post-operative complications among patients ≥80 years of age. Additional randomized control trials studying post-PD operative outcomes in elderly vs. younger patients with standardization of comorbidities is therefore necessary to confirm the conclusions presented here.