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1. Discharge protocol in acute pancreatitis: an international survey and cohort analysis

Author

Rita Nagy, Klementina Ocskay, Zoltán Sipos, Andrea Szentesi, Áron Vincze, László Czakó, Ferenc Izbéki, Natalia V. Shirinskaya, Vladimir L. Poluektov, Alexandr N. Zolotov, Yin Zhu, Liang Xia, Wenhua He, Robert Sutton, Peter Szatmary, Rajarshi Mukherjee, Isobel Saffron Burridge, Emma Wauchope, Elsa Francisco, David Aparicio, Bruno Pinto, António Gomes, Vitor Nunes, Vasile Marcel Tantau, Emanuela Denisa Sagau, Alina Ioana Tantau, Andra Iulia Suceveanu, Cristina Tocia, Andrei Dumitru, Elizabeth Pando, Piero Alberti, Arturo Cirera, Xavier Molero, Hong Sik Lee, Min Kyu Jung, Eui Joo Kim, Sanghyub Lee, María Lourdes Ruiz Rebollo, Reyes Busta Nistal, Sandra Izquierdo Santervas, Dusan Lesko, Marek Soltes, Jozef Radonak, Hubert Zatorski, Ewa Małecka-Panas, Adam Fabisiak, M. Susak Yaroslav, V. Maksymenko Mykhailo, A. Tkachenko Olekcandr, Giedrius Barauskas, Vytautas Simanaitis, Povilas Ignatavicius, Mariana Jinga, Vasile-Daniel Balaban, Cristina Patoni, Liang Gong, Kai Song, Yunlong Li, T. Cúrdia Gonçalves, Marta Freitas, Vítor Macedo, Marlies Vornhuelz, Sarah Klauss, Georg Beyer, Aydin Seref Koksal, Mukaddes Tozlu, Ahmet Tarik Eminler, Nuria Torres Monclús, Eva Pijoan Comas, Juan Armando Rodriguez Oballe, Łukasz Nawacki, Stanisław Głuszek, Alberto Rama-Fernández, Marco Galego, Daniel de la Iglesia, Umut Emre Aykut, Deniz Güney Duman, Rahmi Aslan, Adriana Gherbon, Lihui Deng, Wei Huang, Qing Xia, Goran Poropat, Anja Radovan, Luka Vranić, Claudio Ricci, Carlo Ingaldi, Riccardo Casadei, Ionut Negoi, Cezar Ciubotaru, Florin Mihail Iordache, Gabriel Constantinescu, Vasile Sandru, Engin Altintas, Hatice Rizaoglu Balci, Júlio Constantino, Débora Aveiro, Jorge Pereira, Suleyman Gunay, Seda Misirlioglu Sucan, Oleksiy Dronov, Inna Kovalska, Nikhil Bush, Surinder Singh Rana, Serge Chooklin, Serhii Chuklin, Ionut Adrian Saizu, Cristian Gheorghe, Philipp Göltl, Michael Hirth, Radu Bogdan Mateescu, Geanina Papuc, Georgi Angelov Minkov, Emil Tihomirov Enchev, Laura Mastrangelo, Elio Jovine, Weiwei Chen, Quping Zhu, Anita Gąsiorowska, Natalia Fabisiak, Mihailo Bezmarevic, Andrey Litvin, Martina Cattani Mottes, Eun Kwang Choi, Peter Bánovčin, Lenka Nosáková, Mila Dimitrova Kovacheva-Slavova, Ali Kchaou, Ahmed Tlili, Marco V. Marino, Katarzyna Kusnierz, Artautas Mickevicius, Marcus Hollenbach, Pavol Molcan, Orestis Ioannidis, Mark Valerievich Tokarev, Ali Tüzün Ince, Ivan Albertovich Semenenko, Shamil Galeev, Elena Ramírez-Maldonado, Ville Sallinen, Petr Pencik, Judit Bajor, Patricia Sarlós, Roland Hágendorn, Szilárd Gódi, Imre Szabó, József Czimmer, Gabriella Pár, Anita Illés, Nándor Faluhelyi, Péter Kanizsai, Tamás Nagy, Alexandra Mikó, Balázs Németh, József Hamvas, Barnabás Bod, Márta Varga, Imola Török, János Novák, Árpád Patai, János Sümegi, Csaba Góg, Mária Papp, Bálint Erőss, Szilárd Váncsa, Brigitta Teutsch, Katalin Márta, Péter Jenő Hegyi, Tamás Tornai, Balázs Lázár, Tamás Hussein, Dorottya Tarján, Mónika Lipp, Beáta Kovács, Orsolya Urbán, Emese Fürst, Edina Tari, Ibolya Kocsis, Pál Maurovich-Horvát, Balázs Tihanyi, Orsolya Eperjesi, Zita Kormos, Pál Ákos Deák, Andrea Párniczky, and Péter Hegyi

Subjects
Medicine, Science
Abstract

Abstract There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p

Published
2023
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2. Rate of Post-Operative Pancreatic Fistula after Robotic-Assisted Pancreaticoduodenectomy with Pancreato-Jejunostomy versus Pancreato-Gastrostomy: A Retrospective Case Matched Comparative Study

Author

Marco V. Marino, Adrian Kah Heng Chiow, Antonello Mirabella, Gianpaolo Vaccarella, and Andrzej L. Komorowski

Subjects
robotic pancreatic surgery, pancreato-gastrostomy, pancreatic fistula, Medicine
Abstract

Background: Different techniques of pancreatic anastomosis have been described, with inconclusive results in terms of pancreatic fistula reduction. Studies comparing robotic pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are scarcely reported. Methods: The present study analyzes the outcomes of two case-matched groups of patients who underwent PG (n = 20) or PJ (n = 40) after pancreaticoduodenectomy. The primary aim was to compare the rate of post-operative pancreatic fistula. Results: Operative time (375 vs. 315 min, p = 0.34), estimated blood loss (270 vs. 295 mL, p = 0.44), and rate of clinically relevant post-operative pancreatic fistula (12.5% vs. 10%, p = 0.82) were similar between the two groups. PJ was associated with a higher rate of intra-abdominal collections (7.5% vs. 0%, p = 0.002), but lower post-pancreatectomy hemorrhage (2.5% vs. 10%, p = 0.003). PG was associated with a lower rate of post-operative pancreatic fistula (POPF) (33.3% vs. 50%, p = 0.003) in the high-risk group of patients. Conclusions: The outcomes of post-operative pancreatic fistula are comparable between the two reconstruction techniques. PG may have a lower incidence of POPF in patients with high-risk of pancreatic fistula.

Published
2021
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3. Use and outcome of minimally invasive pancreatic surgery in the European E-MIPS registry

Author

Nicky van der Heijde, Frederique L. Vissers, Alberto Manzoni, Giuseppe Zimmitti, Joaquim Balsells, Frederik Berrevoet, Bergthor Bjornsson, Peter van den Boezem, Ugo Boggi, Svein O. Bratlie, Fernando Burdio, Andrea Coratti, Mathieu D'Hondt, Carlos D. Del Pozo, Safi Dokmak, Regis Fara, Mehmet F. Can, Sebastiaan Festen, Antonello Forgione, Claus Fristrup, Sebastien Gaujoux, Bas Groot Koerkamp, Thilo Hackert, Igor E. Khatkov, Tobias Keck, Hanna Seppänen, Daan Lips, Misha Luyer, Gabriella Pittau, Manuel Maglione, I. Quintus Molenaar, Patrick Pessaux, Geert Roeyen, Olivier Saint-Marc, Santiago S. Cabus, Hjalmar van Santvoort, George van der Schelling, Mario Serradilla-Martin, Francois-regis Souche, Miguel Á. Suarez Muñoz, Marco V. Marino, Marc G. Besselink, Mohammed Abu Hilal, Caroline Vilhav, Vera Hartman, Jakob Kirkegård, Gregory Sergeant, Jörg Kleeff, Marielle Coolsen, Roberto Coppola, Bruno Pauletti, Christof Mittermair, Bobby Tingstedt, Mert Erkan, Ales Tomazic, Dimitris Korkolis, Surgery, European Consortium on Minimally Invasive Pancreatic Surgery, Graduate School, CCA - Cancer Treatment and Quality of Life, CCA - Imaging and biomarkers, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Hepatology, Gastroenterology, Human medicine
Abstract

BACKGROUND: The European registry for minimally invasive pancreatic surgery (E-MIPS) collects data on laparoscopic and robotic MIPS in low- and high-volume centers across Europe.METHODS: Analysis of the first year (2019) of the E-MIPS registry, including minimally invasive distal pancreatectomy (MIDP) and minimally invasive pancreatoduodenectomy (MIPD). Primary outcome was 90-day mortality.RESULTS: Overall, 959 patients from 54 centers in 15 countries were included, 558 patients underwent MIDP and 401 patients MIPD. Median volume of MIDP was 10 (7-20) and 9 (2-20) for MIPD. Median use of MIDP was 56.0% (IQR 39.0-77.3%) and median use of MIPD 27.7% (IQR 9.7-45.3%). MIDP was mostly performed laparoscopic (401/558, 71.9%) and MIPD mostly robotic (234/401, 58.3%). MIPD was performed in 50/54 (89.3%) centers, of which 15/50 (30.0%) performed ≥20 MIPD annually. This was 30/54 (55.6%) centers and 13/30 (43%) centers for MIPD respectively. Conversion rate was 10.9% for MIDP and 8.4% for MIPD. Overall 90 day mortality was 1.1% (n = 6) for MIDP and 3.7% (n = 15) for MIPD.CONCLUSION: Within the E-MIPS registry, MIDP is performed in about half of all patients, mostly using laparoscopy. MIPD is performed in about a quarter of patients, slightly more often using the robotic approach. A minority of centers met the Miami guideline volume criteria for MIPD.

Published
2023

4. A scoring system for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas

Author

Alba, Manuel-Vázquez, Anita, Balakrishnan, Paul, Agami, Bodil, Andersson, Frederik, Berrevoet, Marc G, Besselink, Ugo, Boggi, Damiano, Caputo, Alberto, Carabias, Lucia, Carrion-Alvarez, Carmen Cepeda, Franco, Alessandro, Coppola, Bobby V M, Dasari, Sherley, Diaz-Mercedes, Michail, Feretis, Constantino, Fondevila, Giuseppe Kito, Fusai, Giuseppe, Garcea, Victor, Gonzabay, Miguel Ángel Gómez, Bravo, Myrte, Gorris, Bart, Hendrikx, Camila, Hidalgo-Salinas, Prashant, Kadam, Dimitrios, Karavias, Emanuele, Kauffmann, Amar, Kourdouli, Vincenzo, La Vaccara, Stijn, van Laarhoven, James, Leighton, Mike S L, Liem, Nikolaos, Machairas, Dimitris, Magouliotis, Adel, Mahmoud, Marco V, Marino, Marco, Massani, Paola Melgar, Requena, Keno, Mentor, Niccolò, Napoli, Jorieke H T, Nijhuis, Andrej, Nikov, Cristina, Nistri, Victor, Nunes, Eduardo Ortiz, Ruiz, Sanjay, Pandanaboyana, Baltasar Pérez, Saborido, Radek, Pohnán, Mariuca, Popa, Belinda Sánchez, Pérez, Francisco Sánchez, Bueno, Alejandro, Serrablo, Mario, Serradilla-Martín, James R A, Skipworth, Kjetil, Soreide, Dimitris, Symeonidis, Dimitris, Zacharoulis, Piotr, Zelga, Daniel, Aliseda, María Jesús Castro, Santiago, Carlos Fernández, Mancilla, Raquel Latorre, Fragua, Daniel Llwyd, Hughes, Carmen Payá, Llorente, Mickaël, Lesurtel, Tom, Gallagher, José Manuel, Ramia, Surgery, CCA - Cancer Treatment and Quality of Life, CCA - Imaging and biomarkers, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, and Graduate School

Subjects
Intraductal papillary mucinous neoplasm, Pancreatic Intraductal Neoplasms, Score, Malignancy, Preoperative diagnosis, Adenocarcinoma, Mucinous, intraductal papillary mucinous neoplasm, malignancy, pancreatic neoplasm, preoperative diagnosis, score, Pancreatic Neoplasms, Humans, Surgery, Pancreatic neoplasm, Pancreas, Carcinoma, Pancreatic Ductal, Retrospective Studies
Abstract

Purpose A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. Methods An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. Results A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score >= 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. Conclusion Patients with a Shin score

Published
2022

5. Impact of neoadjuvant chemotherapy on the difficulty and outcomes of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study

Author

Jacob Ghotbi, Davit Aghayan, Åsmund Fretland, Bjørn Edwin, Nicholas L. Syn, Federica Cipriani, Mohammed Alzoubi, Chetana Lim, Olivier Scatton, Tran Cong duy Long, Paulo Herman, Fabricio Ferreira Coelho, Marco V. Marino, Vincenzo Mazzaferro, Adrian K.H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Alejandro Mejia, James O. Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Chung-Ngai Tang, Charing C.N. Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T. Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Franco Pascual, Daniel Cherqui, Xiao Liang, Alessandro Mazzotta, Go Wakabayashi, Mariano Giglio, Roberto I. Troisi, Ho-Seong Han, Tan-To Cheung, Atsushi Sugioka, Kuo-Hsin Chen, Rong Liu, Olivier Soubrane, David Fuks, Luca Aldrighetti, Mohammad Abu Hilal, Brian K.P. Goh, Mikel Gastaca, Juul Meurs, Celine De Meyere, Kit-Fai Lee, Kelvin K. Ng, Diana Salimgereeva, Ruslan Alikhanov, Lip-Seng Lee, Jae Young Jang, Yutaro Kato, Masayuki Kojima, Jaime Arthur Pirola Kruger, Victor Lopez-Lopez, Margarida Casellas I Robert, Roberto Montalti, Boram Lee, Mizelle D'Silva, Hao-Ping Wang, Mansour Saleh, Zewei Chen, Shian Yu, Simone Vani, Francesco Ardito, Ugo Giustizieri, Davide Citterio, Federico Mocchegiani, Marco Colasanti, Yoelimar Guzmán, Kevin P. Labadie, Maria Conticchio, Epameinondas Dogeas, Emanuele F. Kauffmann, Mario Giuffrida, Daniele Sommacale, Alexis Laurent, Paolo Magistri, Phan Phuoc Nghia, Kohei Mishima, Bernardo Dalla Valle, Felix Krenzien, Moritz Schmelzle, Prashant Kadam, Qu Liu, Eric C.H. Lai, Junhao Zheng, Tiing Foong Siow, and Fabio Forchino

Subjects
Robotic liver resections, Oncology, Laparoscopic liver resections, Major resections, Settore MED/18 - CHIRURGIA GENERALE, Surgery, General Medicine, Difficulty, Neoadjuvant chemotherapy
Published
2023

6. Impact of body mass index on the difficulty and outcomes of laparoscopic left lateral sectionectomy

Author

Zewei Chen, Mengqiu Yin, Junhao Fu, Shian Yu, Nicholas L. Syn, Darren W. Chua, T. Peter Kingham, Wanguang Zhang, Tijs J. Hoogteijling, Davit L. Aghayan, Tiing Foong Siow, Olivier Scatton, Paulo Herman, Marco V. Marino, Vincenzo Mazzaferro, Adrian K.H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Safi Dokmak, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O. Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Eric C.H. Lai, Charing C.N. Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, Qu Liu, Rong Liu, Alessandro Ferrero, Giuseppe Maria Ettorre, Federica Cipriani, Daniel Cherqui, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I. Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Ho-Seong Han, Tran Cong duy Long, David Fuks, Mohammad Abu Hilal, Luca Aldrighetti, Kuo-Hsin Chen, Bjørn Edwin, Brian K.P. Goh, Mikel Gastaca, Juul Meurs, Celine De Meyere, Kit-Fai Lee, Kelvin K. Ng, Diana Salimgereeva, Ruslan Alikhanov, Lip-Seng Lee, Jae-Young Jang, Masayuki Kojima, Jaime Arthur Pirola Kruger, Fabricio Ferreira Coelho, Victor Lopez-Lopez, Margarida Casellas I Robert, Roberto Montalti, Mariano Giglio, Mizelle D'Silva, Boram Lee, Hao-Ping Wang, Franco Pascual, Mansour Saleh, Simone Vani, Francesco Ardito, Ugo Giustizieri, Davide Citterio, Federico Mocchegiani, Giammauro Berardi, Marco Colasanti, Yoelimar Guzmán, Kevin P. Labadie, Maria Conticchio, Epameinondas Dogeas, Emanuele F. Kauffmann, Mario Giuffrida, Daniele Sommacale, Alexis Laurent, Paolo Magistri, Kohei Mishima, Moritz Schmelzle, Felix Krenzien, Prashant Kadam, Jacob Ghotbi, Åsmund Avdem Fretland, Fabio Forchino, Alessandro Mazzotta, Francois Cauchy, Chetana Lim, Bernardo Dalla Valle, Junhao Zheng, Phan Phuoc Nghia, and Graduate School

Subjects
Minimally-invasive liver, Oncology, Left lateral sectionectomy, Laparoscopic hepatectomy, Laparoscopic liver, Minimally-invasive hepatectomy, Surgery, General Medicine, Body mass index
Abstract

Introduction: Currently, the impact of body mass index (BMI) on the outcomes of laparoscopic liver resections (LLR) is poorly defined. This study attempts to evaluate the impact of BMI on the peri-operative outcomes following laparoscopic left lateral sectionectomy (L-LLS). Methods: A retrospective analysis of 2183 patients who underwent pure L-LLS at 59 international centers between 2004 and 2021 was performed. Associations between BMI and selected peri-operative outcomes were analyzed using restricted cubic splines. Results: A BMI of >27kg/m2 was associated with increased in blood loss (Mean difference (MD) 21 mls, 95% CI 5–36), open conversions (Relative risk (RR) 1.13, 95% CI 1.03–1.25), operative time (MD 11 min, 95% CI 6–16), use of Pringles maneuver (RR 1.15, 95% CI 1.06–1.26) and reductions in length of stay (MD -0.2 days, 95% CI -0.3 to −0.1). The magnitude of these differences increased with each unit increase in BMI. However, there was a “U” shaped association between BMI and morbidity with the highest complication rates observed in underweight and obese patients. Conclusion: Increasing BMI resulted in increasing difficulty of L-LLS. Consideration should be given to its incorporation in future difficulty scoring systems in laparoscopic liver resections.

Published
2023

7. ASO Visual Abstract: Robotic Versus Laparoscopic Left and Extended Left Hepatectomy-An International Multicenter Study Propensity-Score-Matched Analysis

Author

Iswanto, Sucandy, Shlomi, Rayman, Eric C, Lai, Chung-Ngai, Tang, Yvette, Chong, Mikhail, Efanov, David, Fuks, Gi-Hong, Choi, Charing C, Chong, Adrian K H, Chiow, Marco V, Marino, Mikel, Prieto, Jae-Hoon, Lee, T Peter, Kingham, Mathieu, D'Hondt, Roberto I, Troisi, Sung-Hoon, Choi, Robert P, Sutcliffe, Tan-To, Cheung, Fernando, Rotellar, James O, Park, Olivier, Scatton, Ho-Seong, Han, Johann, Pratschke, Xiaoying, Wang, Rong, Liu, Brian K P, Goh, and Mariano, Giglio

Subjects
Treatment Outcome, Postoperative Complications, Robotic Surgical Procedures, Liver Neoplasms, Humans, Hepatectomy, Laparoscopy, Length of Stay, Propensity Score, Retrospective Studies
Published
2022

8. An international multicentre propensity score matched analysis comparing between robotic versus laparoscopic left lateral sectionectomy

Author

Yvette, Chong, Mikel, Prieto, Mikel, Gastaca, Sung-Hoon, Choi, Iswanto, Sucandy, Adrian K H, Chiow, Marco V, Marino, Xiaoying, Wang, Mikhail, Efanov, Henri, Schotte, Mathieu, D'Hondt, Gi-Hong, Choi, Felix, Krenzien, Moritz, Schmelzle, Johann, Pratschke, T Peter, Kingham, Mariano, Giglio, Roberto I, Troisi, Jae Hoon, Lee, Eric C, Lai, Chung Ngai, Tang, David, Fuks, Mizelle, D'Silva, Ho-Seong, Han, Prashant, Kadam, Robert P, Sutcliffe, Kit-Fai, Lee, Charing C, Chong, Tan-To, Cheung, Qiu, Liu, Rong, Liu, Brian K P, Goh, and Roberto, Montalti

Abstract

Left lateral sectionectomy (LLS) is one of the most commonly performed minimally invasive liver resections. While laparoscopic (L)-LLS is a well-established technique, over traditional open resection, it remains controversial if robotic (R)-LLS provides any advantages of L-LLS.A post hoc analysis of 997 patients from 21 international centres undergoing L-LLS or R-LLS from 2006 to 2020 was conducted. A total of 886 cases (214 R-LLS, 672 L-LLS) met study criteria. 1:1 and 1:2 propensity score matched (PSM) comparison was performed between R-LLSL-LLS. Further subset analysis by Iwate difficulty was also performed. Outcomes measured include operating time, blood loss, open conversion, readmission rates, morbidity and mortality.Comparison between R-LLS and L-LLS after PSM 1:2 demonstrated statistically significantly lower open conversion rate in R-LLS than L-LLS (0.6% versus 5%, p = 0.009) and median blood loss was also statistically significantly lower in R-LLS at 50 (80) versus 100 (170) in L-LLS (p = 0.011) after PSM 1:1 although there was no difference in the blood transfusion rate. Pringle manoeuvre was also found to be used more frequently in R-LLS, with 53(24.8%) cases versus to 84(12.5%) L-LLS cases (p 0.001). There was no significant difference in the other key perioperative outcomes such as operating time, length of stay, postoperative morbidity, major morbidity and 90-day mortality between both groups.R-LLS was associated with similar key perioperative outcomes compared to L-LLS. It was also associated with significantly lower blood loss and open conversion rates compared to L-LLS.

Published
2022

9. Robotic Versus Laparoscopic Left and Extended Left Hepatectomy: An International Multicenter Study Propensity Score-Matched Analysis

Author

Iswanto, Sucandy, Shlomi, Rayman, Eric C, Lai, Chung-Ngai, Tang, Yvette, Chong, Mikhail, Efanov, David, Fuks, Gi-Hong, Choi, Charing C, Chong, Adrian K H, Chiow, Marco V, Marino, Mikel, Prieto, Jae-Hoon, Lee, T Peter, Kingham, Mathieu, D'Hondt, Roberto I, Troisi, Sung Hoon, Choi, Robert P, Sutcliffe, Tan-To, Cheung, Fernando, Rotellar, James O, Park, Olivier, Scatton, Ho-Seong, Han, Johann, Pratschke, Xiaoying, Wang, Rong, Liu, Brian K P, Goh, and Kevin P, Labadie

Subjects
Treatment Outcome, Postoperative Complications, Robotic Surgical Procedures, Liver Neoplasms, Humans, Hepatectomy, Laparoscopy, Length of Stay, Propensity Score, Retrospective Studies
Abstract

Controversies exist among liver surgeons regarding clinical outcomes of the laparoscopic versus the robotic approach for major complex hepatectomies. The authors therefore designed a study to examine and compare the perioperative outcomes of laparoscopic left hepatectomy or extended left hepatectomy (L-LH/L-ELH) versus robotic left hepatectomy or extended left hepatectomy (R-LH/R-ELH) using a large international multicenter collaborative database.An international multicenter retrospective analysis of 580 patients undergoing L-LH/L-ELH or R-LH/R-ELH at 25 specialized hepatobiliary centers worldwide was undertaken. Propensity score-matching (PSM) was used at a 1:1 nearest-neighbor ratio according to 15 perioperative variables, including demographics, tumor characteristics, Child-Pugh score, presence of portal hypertension, multiple resections, histologic diagnosis, and Iwate difficulty grade.Before the PSM, 190 (32 %) patients underwent R-LH/R-ELH, and 390 (68 %) patients underwent L-LH/L-ELH. After the matching, 164 patients were identified in each arm without significant differences in demographics, preoperative variables, medical history, tumor pathology, tumor characteristics, or Iwate score. Regarding intra- and postoperative outcomes, the rebotic approach had significantly less estimated blood loss (EBL) (100 ml [IQR 200 ml] vs 200 ml [IQR 235 ml]; p = 0.029), fewer conversions to open operations (n = 4 [2.4 %] vs n = 13, [7.9 %]; p = 0.043), and a shorter hospital stay (6 days [IQR 3 days] vs 7 days [IQR 3.3 days]; p = 0.009).Both techniques are safe and feasible in major hepatic resections. Compared with L-LH/L-ELH, R-LH/R-ELH is associated with less EBL, fewer conversions to open operations, and a shorter hospital stay.

Published
2022

10. Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study

Author

Hao Ping Wang, Chee Chien Yong, Andrew G.R. Wu, Daniel Cherqui, Roberto I. Troisi, Federica Cipriani, Davit Aghayan, Marco V. Marino, Andrea Belli, Adrian K.H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Marco Vivarelli, Fabrizio Di Benedetto, Sung-Hoon Choi, Jae Hoon Lee, James O. Park, Mikel Gastaca, Constantino Fondevila, Mikhail Efanov, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Chung Ngai Tang, Charing C. Chong, Mathieu D’Hondt, Andrea Ruzzenente, Paolo Herman, T. Peter Kingham, Olivier Scatton, Rong Liu, Alessandro Ferrero, Giovanni Battista Levi Sandri, Olivier Soubrane, Alejandro Mejia, Santiago Lopez-Ben, Jasper Sijberden, Kazuteru Monden, Go Wakabayashi, Atsushi Sugioka, Tan-To Cheung, Tran Cong Duy Long, Bjorn Edwin, Ho-Seong Han, David Fuks, Luca Aldrighetti, Mohamed Abu Hilal, Brian K.P. Goh, Chung-Yip Chan, Nicholas Syn, Mikel Prieto, Henri Schotte, Celine De Meyere, Felix Krenzien, Moritz Schmelzle, Kit-Fai Lee, Diana Salimgereeva, Ruslan Alikhanov, Lip Seng Lee, Jae Young Jang, Kevin P. Labadie, Masayuki Kojima, Yutaro Kato, Asmund Avdem Fretland, Jacob Ghotbi, Fabricio Ferreira Coelho, Jaime Arthur Pirola Kruger, Victor Lopez-Lopez, Paolo Magistri, Bernardo Dalla Valle, Margarida Casellas I Robert, Kohei Mishima, Giuseppe Maria Ettorre, Federico Mocchegiani, Prashant Kadam, Franco Pascual, Mansour Saleh, Alessandro Mazzotta, Roberto Montalti, Mariano Giglio, Boram Lee, Mizelle D’Silva, Phan Phuoc Nghia, Chetana Lim, Qu Liu, Eric C. Lai, Wang, Hao Ping, Yong, Chee Chien, Wu, Andrew G R, Cherqui, Daniel, Troisi, Roberto I, Cipriani, Federica, Aghayan, Davit, Marino, Marco V, Belli, Andrea, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Vivarelli, Marco, Di Benedetto, Fabrizio, Choi, Sung-Hoon, Lee, Jae Hoon, Park, James O, Gastaca, Mikel, Fondevila, Constantino, Efanov, Mikhail, Rotellar, Fernando, Choi, Gi-Hong, Campos, Ricardo Roble, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Tang, Chung Ngai, Chong, Charing C, D'Hondt, Mathieu, Ruzzenente, Andrea, Herman, Paolo, Kingham, T Peter, Scatton, Olivier, Liu, Rong, Ferrero, Alessandro, Levi Sandri, Giovanni Battista, Soubrane, Olivier, Mejia, Alejandro, Lopez-Ben, Santiago, Sijberden, Jasper, Monden, Kazuteru, Wakabayashi, Go, Sugioka, Atsushi, Cheung, Tan-To, Long, Tran Cong Duy, Edwin, Bjorn, Han, Ho-Seong, Fuks, David, Aldrighetti, Luca, Abu Hilal, Mohamed, Goh, Brian K P, Wang, H. P., Yong, C. C., Wu, A. G. R., Cherqui, D., Troisi, R. I., Cipriani, F., Aghayan, D., Marino, M. V., Belli, A., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Vivarelli, M., Di Benedetto, F., Choi, S. -H., Lee, J. H., Park, J. O., Gastaca, M., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. N., Chong, C. C., D'Hondt, M., Ruzzenente, A., Herman, P., Kingham, T. P., Scatton, O., Liu, R., Ferrero, A., Levi Sandri, G. B., Soubrane, O., Mejia, A., Lopez-Ben, S., Sijberden, J., Monden, K., Wakabayashi, G., Sugioka, A., Cheung, T. -T., Long, T. C. D., Edwin, B., Han, H. -S., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Chan, C. -Y., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. S., Jang, J. Y., Labadie, K. P., Kojima, M., Kato, Y., Fretland, A. A., Ghotbi, J., Coelho, F. F., Pirola Kruger, J. A., Lopez-Lopez, V., Magistri, P., Valle, B. D., Casellas I Robert, M., Mishima, K., Ettorre, G. M., Mocchegiani, F., Kadam, P., Pascual, F., Saleh, M., Mazzotta, A., Montalti, R., Giglio, M., Lee, B., D'Silva, M., Nghia, P. P., Lim, C., Liu, Q., Lai, E. C., Graduate School, Surgery, and CCA - Cancer Treatment and Quality of Life

Subjects
Male, Operative Time, Length of Stay, Conversion to Open Surgery, Hepatectomy, Humans, Minimally Invasive Surgical Procedures, Postoperative Complications, Retrospective Studies, Treatment Outcome, Hypertension, Portal, Laparoscopy, Neoplasms, Hypertension, Surgery, Portal
Abstract

Background: Despite the rapid advances that minimally invasive liver resection has gained in recent decades, open conversion is still inevitable in some circumstances. In this study, we aimed to determine the risk factors for open conversion after minimally invasive left lateral sectionectomy, and its impact on perioperative outcomes. Methods: This is a post hoc analysis of 2,445 of 2,678 patients who underwent minimally invasive left lateral sectionectomy at 45 international centers between 2004 and 2020. Factors related to open conversion were analyzed via univariate and multivariate analyses. One-to-one propensity score matching was used to analyze outcomes after open conversion versus non-converted cases. Results: The open conversion rate was 69/2,445 (2.8%). On multivariate analyses, male gender (3.6% vs 1.8%, P = .011), presence of clinically significant portal hypertension (6.1% vs 2.6%, P = .009), and larger tumor size (50 mm vs 32 mm, P < .001) were identified as independent factors associated with open conversion. The most common reason for conversion was bleeding in 27/69 (39.1%) of cases. After propensity score matching (65 open conversion vs 65 completed via minimally invasive liver resection), the open conversion group was associated with increased operation time, blood transfusion rate, blood loss, and postoperative stay compared with cases completed via the minimally invasive approach. Conclusion: Male sex, portal hypertension, and larger tumor size were predictive factors of open conversion after minimally invasive left lateral sectionectomy. Open conversion was associated with inferior perioperative outcomes compared with non-converted cases.

Published
2022

11. Recurrent acute pancreatitis prevention by the elimination of alcohol and cigarette smoking (REAPPEAR): protocol of a randomised controlled trial and a cohort study

Author

Klementina Ocskay, Márk Félix Juhász, Nelli Farkas, Noémi Zádori, Lajos Szakó, Zsolt Szakács, Andrea Szentesi, Bálint Erőss, Emőke Miklós, Antal Zemplényi, Béla Birkás, Árpád Csathó, István Hartung, Tamás Nagy, László Czopf, Ferenc Izbéki, László Gajdán, Mária Papp, László Czakó, Dóra Illés, Marco V Marino, Antonello Mirabella, Ewa Małecka-Panas, Hubert Zatorski, Yaroslav Susak, Kristina Opalchuk, Gabriele Capurso, Laura Apadula, Cristian Gheorghe, Ionut Adrian Saizu, Ole H Petersen, Enrique de-Madaria, Jonas Rosendahl, Andrea Párniczky, and Péter Hegyi

Subjects
substance misuse, Gastroenterology and Hepatology, General Medicine, preventive medicine, pancreatic disease
Abstract

Background/objectivesAcute recurrent pancreatitis (ARP) due to alcohol and/or tobacco abuse is a preventable disease which lowers quality of life and can lead to chronic pancreatitis. The REAPPEAR study aims to investigate whether a combined patient education and cessation programme for smoking and alcohol prevents ARP.Methods and analysisThe REAPPEAR study consists of an international multicentre randomised controlled trial (REAPPEAR-T) testing the efficacy of a cessation programme on alcohol and smoking and a prospective cohort study (REAPPEAR-C) assessing the effects of change in alcohol consumption and smoking (irrespective of intervention). Daily smoker patients hospitalised with alcohol-induced acute pancreatitis (AP) will be enrolled. All patients will receive a standard intervention priorly to encourage alcohol and smoking cessation. Participants will be subjected to laboratory testing, measurement of blood pressure and body mass index and will provide blood, hair and urine samples for later biomarker analysis. Addiction, motivation to change, socioeconomic status and quality of life will be evaluated with questionnaires. In the trial, patients will be randomised either to the cessation programme with 3-monthly visits or to the control group with annual visits. Participants of the cessation programme will receive a brief intervention at every visit with direct feedback on their alcohol consumption based on laboratory results. The primary endpoint will be the composite of 2-year all-cause recurrence rate of AP and/or 2-year all-cause mortality. The cost-effectiveness of the cessation programme will be evaluated. An estimated 182 participants will be enrolled per group to the REAPPEAR-T with further enrolment to the cohort.Ethics and disseminationThe study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (40394-10/2020/EÜIG), all local ethical approvals are in place. Results will be disseminated at conferences and in peer-reviewed journals.Trial registration numberNCT04647097

Published
2022

12. International multicentre propensity score-matched analysis comparing robotic versus laparoscopic right posterior sectionectomy

Author

Adrian K H, Chiow, David, Fuks, Gi-Hong, Choi, Nicholas, Syn, Iswanto, Sucandy, Marco V, Marino, Mikel, Prieto, Charing C, Chong, Jae Hoon, Lee, Mikhail, Efanov, T Peter, Kingham, Sung Hoon, Choi, Robert P, Sutcliffe, Roberto I, Troisi, Johann, Pratschke, Tan-To, Cheung, Xiaoying, Wang, Rong, Liu, Mathieu, D'Hondt, Chung-Yip, Chan, Chung Ngai, Tang, Ho-Seong, Han, Brian K P, Goh, J Y, Jang, Chiow, A. K. H., Fuks, D., Choi, G. -H., Syn, N., Sucandy, I., Marino, M. V., Prieto, M., Chong, C. C., Lee, J. H., Efanov, M., Kingham, T. P., Choi, S. H., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Cheung, T. -T., Wang, X., Liu, R., D'Hondt, M., Chan, C. -Y., Tang, C. N., Han, H. -S., Goh, B. K. P., and Montalti, R.

Subjects
Male, medicine.medical_specialty, Blood transfusion, Cirrhosis, medicine.medical_treatment, Matched-Pair Analysis, Operative Time, Blood Loss, Surgical, Article, Blood loss, Robotic Surgical Procedures, Retrospective Studie, Operating time, Medicine, Hepatectomy, Humans, Blood Transfusion, Matched-Pair Analysi, Propensity Score, Aged, Retrospective Studies, business.industry, Mortality rate, Perioperative, Middle Aged, medicine.disease, Conversion to Open Surgery, Surgery, Propensity score matching, Right posterior, Female, Laparoscopy, business, Human
Abstract

Background Minimally invasive right posterior sectionectomy (RPS) is a technically challenging procedure. This study was designed to determine outcomes following robotic RPS (R-RPS) and laparoscopic RPS (L-RPS). Methods An international multicentre retrospective analysis of patients undergoing R-RPS versus those who had purely L-RPS at 21 centres from 2010 to 2019 was performed. Patient demographics, perioperative parameters, and postoperative outcomes were analysed retrospectively from a central database. Propensity score matching (PSM) was performed, with analysis of 1 : 2 and 1 : 1 matched cohorts. Results Three-hundred and forty patients, including 96 who underwent R-RPS and 244 who had L-RPS, met the study criteria and were included. The median operating time was 295 minutes and there were 25 (7.4 per cent) open conversions. Ninety-seven (28.5 per cent) patients had cirrhosis and 56 (16.5 per cent) patients required blood transfusion. Overall postoperative morbidity rate was 22.1 per cent and major morbidity rate was 6.8 per cent. The median postoperative stay was 6 days. After 1 : 1 matching of 88 R-RPS and L-RPS patients, median (i.q.r.) blood loss (200 (100–400) versus 450 (200–900) ml, respectively; P 500 ml; P = 0.001), need for intraoperative blood transfusion (10.2 versus 23.9 per cent, respectively; P = 0.014), and open conversion rate (2.3 versus 11.4 per cent, respectively; P = 0.016) were lower in the R-RPS group. Similar results were found in the 1 : 2 matched groups (66 R-RPS versus 132 L-RPS patients). Conclusion R-RPS and L-RPS can be performed in expert centres with good outcomes in well selected patients. R-RPS was associated with reduced blood loss and lower open conversion rates than L-RPS.

Published
2021

14. Correction to: Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

Author

Francesco Fleres, Andrea Borasi, Elisabetta Travaglio, Gianluca Pellino, Salomone Di Saverio, Lucia Romano, Michele Benedetti, Giampaolo Formisano, Pasquale Cianci, Massimiliano Fabozzi, MD, PhD, Gennaro Perrone, Monica Ortenzi, Domenico Spoletini, Elena Bonati, Enrico Crolla, Riccardo ROSATI, Marco V. Marino, Giuseppe Cavallaro, Mauro Podda, Stefano Magnone, Antonio Azzinnaro, Cristina Bombardini, Nicola Cillara, Andrea Barberis, ENRICO OPOCHER, Giuseppe Brisinda, Guido Fiorentini, Fabio Carbone, Matteo Uccelli, Dario Parini, Daniele Delogu, Federico Selvaggi, Pasquale Tammaro, FLAVIO GIORDANO, Giorgio Ammerata, Michele Santangelo, Giovanni Merola, Raffaele Lombardi, Ferdinando Agresta, and Marino Graziella

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pandemic, MEDLINE, Medicine, Correction, Surgery, business, Intensive care medicine
Published
2021

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