ABSTRACT： Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase （ALT）...ABSTRACT： Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase （ALT） correlate with patient outcome after liver resection. We assessed whether postoperative day 1 （POD 1） ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient＇s morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because ofthe low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.展开更多
The growing trend towards minimally invasive hepato-biliary and pancreatic(HPB)surgery has led to the evolution of multiple techniques in the performance of the pancreaticoduodenectomy(PD),either Whipple’s procedure ...The growing trend towards minimally invasive hepato-biliary and pancreatic(HPB)surgery has led to the evolution of multiple techniques in the performance of the pancreaticoduodenectomy(PD),either Whipple’s procedure or pylorus-preserving pancreaticoduodenectomy(PPPD),for lesions in the head of the pancreas and other indications.Recent trials have highlighted the limitations of the laparoscopic technique when it comes to PD.The use of robotic assistance allows surgeons to circumvent these limitations and carry out robotic pancreaticoduodenectomy(RPD)with good outcomes.The technique described has been adopted and practiced in multiple UK HPB centres and is based on a collective experience of performing over 200 purely robotic PDs.The technique has been implemented in over 20 robotic HPB centers across the UK and Europe and has been widely adopted as the go-to technique in the implementation of RPD.The method is described as distinct steps to allow for a systematic stepwise approach to the procedure.This technique is particularly suitable for all cases where there is no risk of vascular involvement,as confirmed by a preoperative scan conducted two weeks prior to surgery,especially in malignant conditions.A video description of all the steps is included with the publication.The method described has been adopted successfully in HPB programs across the UK and some European centers,with some variations according to local preferences.A separate article is being constructed with the data on short and long-term outcomes being collated across the UK centers in a prospective manner.This paper is to share the British technique of purely robotic PD.展开更多
文摘ABSTRACT： Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase （ALT） correlate with patient outcome after liver resection. We assessed whether postoperative day 1 （POD 1） ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient＇s morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because ofthe low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.
文摘The growing trend towards minimally invasive hepato-biliary and pancreatic(HPB)surgery has led to the evolution of multiple techniques in the performance of the pancreaticoduodenectomy(PD),either Whipple’s procedure or pylorus-preserving pancreaticoduodenectomy(PPPD),for lesions in the head of the pancreas and other indications.Recent trials have highlighted the limitations of the laparoscopic technique when it comes to PD.The use of robotic assistance allows surgeons to circumvent these limitations and carry out robotic pancreaticoduodenectomy(RPD)with good outcomes.The technique described has been adopted and practiced in multiple UK HPB centres and is based on a collective experience of performing over 200 purely robotic PDs.The technique has been implemented in over 20 robotic HPB centers across the UK and Europe and has been widely adopted as the go-to technique in the implementation of RPD.The method is described as distinct steps to allow for a systematic stepwise approach to the procedure.This technique is particularly suitable for all cases where there is no risk of vascular involvement,as confirmed by a preoperative scan conducted two weeks prior to surgery,especially in malignant conditions.A video description of all the steps is included with the publication.The method described has been adopted successfully in HPB programs across the UK and some European centers,with some variations according to local preferences.A separate article is being constructed with the data on short and long-term outcomes being collated across the UK centers in a prospective manner.This paper is to share the British technique of purely robotic PD.
