Background:In recent years,the development of digital imaging technology has had a significant influence in liver surgery.The ability to obtain a 3-dimensional(3D)visualization of the liver anatomy has provided surger...Background:In recent years,the development of digital imaging technology has had a significant influence in liver surgery.The ability to obtain a 3-dimensional(3D)visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models,3D printing models and more recently holograms and augmented reality(when virtual reality knowledge is superimposed onto reality).In addition,the utilization of real-time fluorescent imaging techniques based on indocyanine green(ICG)uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma,applying the knowledge obtained preoperatively through digital imaging.The combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception(virtual reality),enhanced with real-time visualization of the fluorescent liver structures,effectively facilitating intraoperative navigated liver surgery(augmented reality).Data sources:A literature search was performed from inception until January 2021 in MEDLINE(Pub Med),Embase,Cochrane library and database for systematic reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases.Results:Fifty-one pertinent articles were retrieved and included.The different types of digital imaging technologies and the real-time navigated liver surgery were estimated and compared.Conclusions:ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments;as a result,precise hepatic resection can be guided by the presence of fluorescence.Furthermore,3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant,delineation of resection lines along the liver segments and evaluation of tumor margins.In liver transplantation and especially in living donor liver transplantation(LDLT),3D printed models of the donor’s liver and models of the recipient’s hilar anatomy can contribute further to improving the results.In particular,pediatric LDLT abdominal cavity models can help to manage the largest challenge of this procedure,namely large-for-size syndrome.展开更多
Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. Th...Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation(MWA), radiofrequency ablation(RFA) and HR by conducting the first network meta-analysis. Data sources: Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. Results: HR cohort demonstrated significantly less local recurrence rate and better 3-and 5-year diseasefree(DFS) and overall survival(OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen(CEA) by 10.28 ng/m L compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. Conclusions: For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.展开更多
Background:The use of laparoscopic(LLR)and robotic liver resections(RLR)has been safely performed in many institutions for liver tumours.A large scale international multicenter study would provide stronger evidence an...Background:The use of laparoscopic(LLR)and robotic liver resections(RLR)has been safely performed in many institutions for liver tumours.A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours≥10 cm.Methods:This was a retrospective review of 971 patients who underwent LLR and RLR for huge(≥10 cm)tumors at 42 international centers between 2002-2020.Results:One hundred RLR and 699 LLR which met study criteria were included.The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching(PSM)(73 vs.219).Before PSM,LLR was associated with significantly increased frequency of previous abdominal surgery,malignant pathology,liver cirrhosis and increased median blood.After PSM,RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time(242 vs.290 min,P=0.286),transfusion rate rate(19.2%vs.16.9%,P=0.652),median blood loss(200 vs.300 mL,P=0.694),open conversion rate(8.2%vs.11.0%,P=0.519),morbidity(28.8%vs.21.9%,P=0.221),major morbidity(4.1%vs.9.6%,P=0.152),mortality and postoperative length of stay(6 vs.6 days,P=0.435).Conclusions:RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes.There was no significant difference in perioperative outcomes after RLR or LLR.展开更多
Background:The implementation of minimally invasive liver resection surgery(MILS)programs starts from procedures with a low degree of technical difficulty.Data regarding the real short-term advantage of laparoscopy ac...Background:The implementation of minimally invasive liver resection surgery(MILS)programs starts from procedures with a low degree of technical difficulty.Data regarding the real short-term advantage of laparoscopy according to technical difficulty are still lacking.The aim of the present study is to evaluate the differential benefit of laparoscopic over open technique according to the technical difficulty of the procedures and to investigate if efforts associated with laparoscopic approach are always justified.Methods:Nine hundred and thirty-six MILS resections performed between 2005 and 2018 were stratified according to technical complexity(low,intermediate and high difficulty)and to approach(MILS or open)and matched in a 1:1 ratio using propensity scores to obtain three pairs of groups(Pair 1:Low-MILS and Low-Open,including 274 cases respectively;Pair 2:Int-MILS and Int-Open,including 237 patients respectively;Pair 3:High-MILS and High-Open,including 226 patients respectively).Results:MILS approach resulted in a statistically significant lower blood loss,reduced morbidity,reduced and shorter time for functional recover and length of stay within all pairs.The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in high degree procedures compared with intermediate and low degree,both in terms of blood loss(-250 and-200 mL respectively)and morbidity rate(-5.7%and-4.1%respectively).Conclusions:The favorable biological scenario associated with laparoscopic approach allows to obtain significant benefits in the setting of technically complex procedures.The commitment towards MILS approach should be therefore stronger in this setting,where the advantage of laparoscopy seems to be enhanced.展开更多
We read with interest the review entitled"Laparoscopic liver resection:the current status and the future"written by Dr.Xiujun Cai and published in Hepatobiliary Surgery and Nutrition(1).
Background:Economic impact of robotic liver surgery(RLS)is still a debated issue due to the heterogeneity of liver resections considered and the lack of a rigorous methodology.Therefore,the aim of this study is to per...Background:Economic impact of robotic liver surgery(RLS)is still a debated issue due to the heterogeneity of liver resections considered and the lack of a rigorous methodology.Therefore,the aim of this study is to perform a time-driven activity-based costing(TD-ABC)comparing the costs of RLS,laparoscopic liver surgery(LLS)and open liver surgery(OLS)in the context of complex liver resections and to compare short term perioperative outcomes.Methods:The institutional databases of two Italian high volume hepatobiliary centres were retrospectively reviewed from February 2021 to April 2022.Patients submitted to major hepatectomies or postero-superior liver resections were selected and divided into three groups according to the approach scheduled(RLS,LLS and OLS)and compared.Major contributors of perioperative expenses were calculated using the TD-ABC model and accurately quantifying each unit resource consumed per patient and the time spent performing each activity.A primary intention-to-treat analysis(ITT-A)including conversions in the RLS and LLS groups was performed.Results:Forty-seven RLS,101 LLS and 124 OLS were collected.LLS and RLS showed reduced blood loss,morbidity,mortality and hospital stay compared with open.A trend towards reduced conversion rate in RLS compared to LLS was registered.Total costs associated with RLS were estimated at€10,637 vs.€9,543 for LLS and vs.€13,960 for OLS.The higher intraoperative costs associated with RLS(+153.3%vs.OLS and+148.2%vs.LLS,P<0.001),primarily related to surgical equipment expenses,were slightly offset by the postoperative savings(−56.0%vs.OLS and−29.4%vs.LLS,P<0.001)resulting from significantly reduced hospital stays.Conclusions:RLS offers economic advantages over OLS,as initial higher costs are offset by better perioperative outcomes.The evolving robotic marketplace is expected to drive down RLS costs,promoting widespread adoption in minimally invasive procedures.Despite its higher costs than LLS,RLS’s ability to enhance minimally invasive feasibility makes it a preferred choice for complex cases,reducing the need for conversions.展开更多
The robotic platform enables surgeons to operate with a similar level of freedom and control as in open surgery,while still providing the patient with the benefits of a minimally invasive approach.More centres continu...The robotic platform enables surgeons to operate with a similar level of freedom and control as in open surgery,while still providing the patient with the benefits of a minimally invasive approach.More centres continue to adopt robotic liver surgery however standardized training materials and consensus on the surgical technique are currently lacking.The availability of a standardized surgical protocol could benefit the further dissemination of the robotic approach while promoting safe and effective operating techniques.We present a comprehensive surgical technique description for robotic hepatectomy agreed upon by seven expert robotic liver surgeons in Europe.They contributed insights from their extensive experience with the robot to develop this report,highlighting the key steps and important considerations for performing robotic hepatectomy.We describe the surgical technique for four most common hepatectomy types with varying complexity:partial anterolateral resections,partial posterosuperior resections,left hepatectomy and right hepatectomy.This report encompasses recommendations from the experts,covering the preparatory steps such as patient selection and pre-operative imaging,and extending through to care in the postoperative phase.The step-by-step surgical technique description serves as a compendium of best practice methods presently utilized in robotic liver surgery.Although some variations in technique cannot be eliminated from practice,general recommendations in a structured form will help to homogenize the technique,safeguarding surgical quality.This paper aims to inform and advise surgeons in the process of adopting robotic liver surgery and can act as a starting point for further optimization and refinement of the technique.展开更多
The aim of this review is to describe the relevance of minimally invasive liver resection(MILR)for the treatment of most common primary liver tumors.The uptake has been slow but steady,and thus MILR has become a well-...The aim of this review is to describe the relevance of minimally invasive liver resection(MILR)for the treatment of most common primary liver tumors.The uptake has been slow but steady,and thus MILR has become a well-established field of hepatobiliary surgery and is considered a landmark change of the past 30 years.There is evidence that the advantage of MILR regarding specific complications of liver surgery for HCC(reduced incidence of postoperative hepatic decompensation and ascites)can be a tool to potentially expand the indications to surgical treatment.Evidence for intrahepatic cholangiocarcinoma is early and exploratory;however,it is beginning to be documented that the fundamental principles of surgical oncology for this tumor can be respected while offering patients the advantages of minimal invasiveness.展开更多
The correlation between decreased blood loss and improved clinical and oncological outcomes has been described in liver surgery:considering that perioperative blood transfusions are associated with a higher rate of re...The correlation between decreased blood loss and improved clinical and oncological outcomes has been described in liver surgery:considering that perioperative blood transfusions are associated with a higher rate of recurrence and lower survival after resection of colorectal liver metastases and hepatocellular carcinoma,any effort to address the task of bleeding control and reduce the need for blood transfusions is of outstanding importance(1).展开更多
Introduction The hybrid robotic-laparoscopic technique has been described-in the field of hepatic surgery-in order to overcome procedural challenges related to the lack of the robotic ultrasonic dissector(1-4):Robo-La...Introduction The hybrid robotic-laparoscopic technique has been described-in the field of hepatic surgery-in order to overcome procedural challenges related to the lack of the robotic ultrasonic dissector(1-4):Robo-Lap approach hence combines the use of the robotic platform(specifically robotic bipolar forceps for coagulation and scissors)with the laparoscopic dissector handled by the surgeon at the table.展开更多
Aim:The study was designed to assess the implications of enhanced recovery after surgery(ERAS)approach in patients submitted to open liver resection for hepatocellular carcinoma(HCC)comparing their short term outcome ...Aim:The study was designed to assess the implications of enhanced recovery after surgery(ERAS)approach in patients submitted to open liver resection for hepatocellular carcinoma(HCC)comparing their short term outcome with patients treated by laparoscopic approach,in a case-matched design.Methods:The open-group(n=60)was matched in a ratio of 1:1 with patients undergoing laparoscopic liver resection for HCC(Lap-group,n=60),with a matching achieved on a basis of propensity scores including 6 covariates representing patients characteristics and severity of the disease.Primary outcome analysis was performed in terms of ERAS-specific items and postoperative morbidity and mortality.Results:Overall morbidity and mortality were comparable between groups.Incidence of ascites was slightly higher in the open-compared with the Lap-group(respectively 11.7%and 13.3%),without statistical significance.The need for introduction or increase of chronic diuretic therapy was significantly higher in the open-compared with the Lap-group(16.7%vs.11.7%,P=0.046).Furthermore,ascites more frequently required percutaneous drainage in the open-compared with the Lap-group(5%vs.1.7%respectively,P=0.041).Conclusion:In patients who can’t benefit from minimally-invasive approach because of disease characteristics,ERAS management seems to be associated with an improved postoperative functional recovery and postoperative outcomes,comparable to those of the minimally invasive approach.展开更多
Combined Hepatocellular-Cholangiocarcinoma is a heterogenous primary malignant epithelial tumor of the liver with variable morphological and immunophenotypical features.Although the biology of this tumor has been desc...Combined Hepatocellular-Cholangiocarcinoma is a heterogenous primary malignant epithelial tumor of the liver with variable morphological and immunophenotypical features.Although the biology of this tumor has been described in the literature,changes in classification and its heterogeneity imply difficulties in collecting reliable homogenous groups to compare.The article aims to review available data on morphology and immunohistochemistry for practicing pathologists integrated with original data from our referral Center.展开更多
文摘Background:In recent years,the development of digital imaging technology has had a significant influence in liver surgery.The ability to obtain a 3-dimensional(3D)visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models,3D printing models and more recently holograms and augmented reality(when virtual reality knowledge is superimposed onto reality).In addition,the utilization of real-time fluorescent imaging techniques based on indocyanine green(ICG)uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma,applying the knowledge obtained preoperatively through digital imaging.The combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception(virtual reality),enhanced with real-time visualization of the fluorescent liver structures,effectively facilitating intraoperative navigated liver surgery(augmented reality).Data sources:A literature search was performed from inception until January 2021 in MEDLINE(Pub Med),Embase,Cochrane library and database for systematic reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases.Results:Fifty-one pertinent articles were retrieved and included.The different types of digital imaging technologies and the real-time navigated liver surgery were estimated and compared.Conclusions:ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments;as a result,precise hepatic resection can be guided by the presence of fluorescence.Furthermore,3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant,delineation of resection lines along the liver segments and evaluation of tumor margins.In liver transplantation and especially in living donor liver transplantation(LDLT),3D printed models of the donor’s liver and models of the recipient’s hilar anatomy can contribute further to improving the results.In particular,pediatric LDLT abdominal cavity models can help to manage the largest challenge of this procedure,namely large-for-size syndrome.
文摘Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation(MWA), radiofrequency ablation(RFA) and HR by conducting the first network meta-analysis. Data sources: Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. Results: HR cohort demonstrated significantly less local recurrence rate and better 3-and 5-year diseasefree(DFS) and overall survival(OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen(CEA) by 10.28 ng/m L compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. Conclusions: For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.
基金Dr.T.P.Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant number P30 CA00878 for this study.
文摘Background:The use of laparoscopic(LLR)and robotic liver resections(RLR)has been safely performed in many institutions for liver tumours.A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours≥10 cm.Methods:This was a retrospective review of 971 patients who underwent LLR and RLR for huge(≥10 cm)tumors at 42 international centers between 2002-2020.Results:One hundred RLR and 699 LLR which met study criteria were included.The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching(PSM)(73 vs.219).Before PSM,LLR was associated with significantly increased frequency of previous abdominal surgery,malignant pathology,liver cirrhosis and increased median blood.After PSM,RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time(242 vs.290 min,P=0.286),transfusion rate rate(19.2%vs.16.9%,P=0.652),median blood loss(200 vs.300 mL,P=0.694),open conversion rate(8.2%vs.11.0%,P=0.519),morbidity(28.8%vs.21.9%,P=0.221),major morbidity(4.1%vs.9.6%,P=0.152),mortality and postoperative length of stay(6 vs.6 days,P=0.435).Conclusions:RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes.There was no significant difference in perioperative outcomes after RLR or LLR.
文摘Background:The implementation of minimally invasive liver resection surgery(MILS)programs starts from procedures with a low degree of technical difficulty.Data regarding the real short-term advantage of laparoscopy according to technical difficulty are still lacking.The aim of the present study is to evaluate the differential benefit of laparoscopic over open technique according to the technical difficulty of the procedures and to investigate if efforts associated with laparoscopic approach are always justified.Methods:Nine hundred and thirty-six MILS resections performed between 2005 and 2018 were stratified according to technical complexity(low,intermediate and high difficulty)and to approach(MILS or open)and matched in a 1:1 ratio using propensity scores to obtain three pairs of groups(Pair 1:Low-MILS and Low-Open,including 274 cases respectively;Pair 2:Int-MILS and Int-Open,including 237 patients respectively;Pair 3:High-MILS and High-Open,including 226 patients respectively).Results:MILS approach resulted in a statistically significant lower blood loss,reduced morbidity,reduced and shorter time for functional recover and length of stay within all pairs.The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in high degree procedures compared with intermediate and low degree,both in terms of blood loss(-250 and-200 mL respectively)and morbidity rate(-5.7%and-4.1%respectively).Conclusions:The favorable biological scenario associated with laparoscopic approach allows to obtain significant benefits in the setting of technically complex procedures.The commitment towards MILS approach should be therefore stronger in this setting,where the advantage of laparoscopy seems to be enhanced.
文摘We read with interest the review entitled"Laparoscopic liver resection:the current status and the future"written by Dr.Xiujun Cai and published in Hepatobiliary Surgery and Nutrition(1).
文摘Background:Economic impact of robotic liver surgery(RLS)is still a debated issue due to the heterogeneity of liver resections considered and the lack of a rigorous methodology.Therefore,the aim of this study is to perform a time-driven activity-based costing(TD-ABC)comparing the costs of RLS,laparoscopic liver surgery(LLS)and open liver surgery(OLS)in the context of complex liver resections and to compare short term perioperative outcomes.Methods:The institutional databases of two Italian high volume hepatobiliary centres were retrospectively reviewed from February 2021 to April 2022.Patients submitted to major hepatectomies or postero-superior liver resections were selected and divided into three groups according to the approach scheduled(RLS,LLS and OLS)and compared.Major contributors of perioperative expenses were calculated using the TD-ABC model and accurately quantifying each unit resource consumed per patient and the time spent performing each activity.A primary intention-to-treat analysis(ITT-A)including conversions in the RLS and LLS groups was performed.Results:Forty-seven RLS,101 LLS and 124 OLS were collected.LLS and RLS showed reduced blood loss,morbidity,mortality and hospital stay compared with open.A trend towards reduced conversion rate in RLS compared to LLS was registered.Total costs associated with RLS were estimated at€10,637 vs.€9,543 for LLS and vs.€13,960 for OLS.The higher intraoperative costs associated with RLS(+153.3%vs.OLS and+148.2%vs.LLS,P<0.001),primarily related to surgical equipment expenses,were slightly offset by the postoperative savings(−56.0%vs.OLS and−29.4%vs.LLS,P<0.001)resulting from significantly reduced hospital stays.Conclusions:RLS offers economic advantages over OLS,as initial higher costs are offset by better perioperative outcomes.The evolving robotic marketplace is expected to drive down RLS costs,promoting widespread adoption in minimally invasive procedures.Despite its higher costs than LLS,RLS’s ability to enhance minimally invasive feasibility makes it a preferred choice for complex cases,reducing the need for conversions.
基金supported by a grant from Intuitive Foundation for the development of the LIVEROBOT European training program in robotic liver surgery.
文摘The robotic platform enables surgeons to operate with a similar level of freedom and control as in open surgery,while still providing the patient with the benefits of a minimally invasive approach.More centres continue to adopt robotic liver surgery however standardized training materials and consensus on the surgical technique are currently lacking.The availability of a standardized surgical protocol could benefit the further dissemination of the robotic approach while promoting safe and effective operating techniques.We present a comprehensive surgical technique description for robotic hepatectomy agreed upon by seven expert robotic liver surgeons in Europe.They contributed insights from their extensive experience with the robot to develop this report,highlighting the key steps and important considerations for performing robotic hepatectomy.We describe the surgical technique for four most common hepatectomy types with varying complexity:partial anterolateral resections,partial posterosuperior resections,left hepatectomy and right hepatectomy.This report encompasses recommendations from the experts,covering the preparatory steps such as patient selection and pre-operative imaging,and extending through to care in the postoperative phase.The step-by-step surgical technique description serves as a compendium of best practice methods presently utilized in robotic liver surgery.Although some variations in technique cannot be eliminated from practice,general recommendations in a structured form will help to homogenize the technique,safeguarding surgical quality.This paper aims to inform and advise surgeons in the process of adopting robotic liver surgery and can act as a starting point for further optimization and refinement of the technique.
文摘The aim of this review is to describe the relevance of minimally invasive liver resection(MILR)for the treatment of most common primary liver tumors.The uptake has been slow but steady,and thus MILR has become a well-established field of hepatobiliary surgery and is considered a landmark change of the past 30 years.There is evidence that the advantage of MILR regarding specific complications of liver surgery for HCC(reduced incidence of postoperative hepatic decompensation and ascites)can be a tool to potentially expand the indications to surgical treatment.Evidence for intrahepatic cholangiocarcinoma is early and exploratory;however,it is beginning to be documented that the fundamental principles of surgical oncology for this tumor can be respected while offering patients the advantages of minimal invasiveness.
文摘The correlation between decreased blood loss and improved clinical and oncological outcomes has been described in liver surgery:considering that perioperative blood transfusions are associated with a higher rate of recurrence and lower survival after resection of colorectal liver metastases and hepatocellular carcinoma,any effort to address the task of bleeding control and reduce the need for blood transfusions is of outstanding importance(1).
文摘Introduction The hybrid robotic-laparoscopic technique has been described-in the field of hepatic surgery-in order to overcome procedural challenges related to the lack of the robotic ultrasonic dissector(1-4):Robo-Lap approach hence combines the use of the robotic platform(specifically robotic bipolar forceps for coagulation and scissors)with the laparoscopic dissector handled by the surgeon at the table.
文摘Aim:The study was designed to assess the implications of enhanced recovery after surgery(ERAS)approach in patients submitted to open liver resection for hepatocellular carcinoma(HCC)comparing their short term outcome with patients treated by laparoscopic approach,in a case-matched design.Methods:The open-group(n=60)was matched in a ratio of 1:1 with patients undergoing laparoscopic liver resection for HCC(Lap-group,n=60),with a matching achieved on a basis of propensity scores including 6 covariates representing patients characteristics and severity of the disease.Primary outcome analysis was performed in terms of ERAS-specific items and postoperative morbidity and mortality.Results:Overall morbidity and mortality were comparable between groups.Incidence of ascites was slightly higher in the open-compared with the Lap-group(respectively 11.7%and 13.3%),without statistical significance.The need for introduction or increase of chronic diuretic therapy was significantly higher in the open-compared with the Lap-group(16.7%vs.11.7%,P=0.046).Furthermore,ascites more frequently required percutaneous drainage in the open-compared with the Lap-group(5%vs.1.7%respectively,P=0.041).Conclusion:In patients who can’t benefit from minimally-invasive approach because of disease characteristics,ERAS management seems to be associated with an improved postoperative functional recovery and postoperative outcomes,comparable to those of the minimally invasive approach.
文摘Combined Hepatocellular-Cholangiocarcinoma is a heterogenous primary malignant epithelial tumor of the liver with variable morphological and immunophenotypical features.Although the biology of this tumor has been described in the literature,changes in classification and its heterogeneity imply difficulties in collecting reliable homogenous groups to compare.The article aims to review available data on morphology and immunohistochemistry for practicing pathologists integrated with original data from our referral Center.
