ANZ Journal of Surgery

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Table of Contents for ANZ Journal of Surgery. List of articles from both the latest and EarlyView issues.
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Clinical efficacy of middle pancreatectomy contrasts distal pancreatectomy: a single‐institution experience and review of literature

March 21, 2019 - 23:29

The middle pancreatectomy is a safe and feasible surgical method. It can well preserve the endocrine and exocrinosity function of pancreas and improve the quality of patient's life.


Background

We aim to analyse the difference of clinical efficacy between middle pancreatectomy (MP) and distal pancreatectomy (DP).

Methods

A retrospective study was used to analyse 39 cases of MP and 52 cases of DP from the Department of Hepatopancreatobiliary Surgery of the Affiliated Hospital of Qingdao University from February 2007 to December 2016. Furthermore, we identify randomized controlled trials or strictly designed clinical controlled trials on MP and DP. We performed a meta‐analysis of the final included studies using RevMan 5.3 software to illustrate the differences in efficacy between MP and DP.

Results

In the MP group, the operation time and diet start time were significantly longer than DP group. However, there was no significant difference in serious complications including clinically significant pancreatic fistula (grades B and C), delayed gastric emptying, reoperative and mortality. Furthermore, compared with DP, patients in MP group could benefit from long‐term post‐operative exocrine and endocrine function. Finally, we performed a meta‐analysis including 14 studies with a total of 1104 patients and proved that the pancreatic fistula rate, endocrine and exocrine function were significantly different in the two groups.

Conclusion

The MP is a safe and feasible surgical method. It can well preserve the endocrine and exocrine function of pancreas and improve the life quality of patients.

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

March 21, 2019 - 19:36

A study over 13 years (2003–2015) was carried out which identified patients who had a colonoscopic perforation and were subsequently managed by the colorectal unit at a single tertiary referral centre. Main outcomes were time of diagnosis, modality of management, time to theatre, length of stay, cost of admission and complications.


Background

The use of colonoscopy has been increasing in Australia. This case series describes management and outcomes of colonoscopic perforation managed by a single tertiary referral unit.

Methods

An analysis of 13 years (2003–2015) of prospectively collected data on patients who had a colonoscopic perforation and were managed by the colorectal unit at a single tertiary referral centre was performed. Main outcomes were time of diagnosis, modality of management, time to theatre, length of stay, cost of admission and complications.

Results

Sixty‐two patients had perforations (median age of 69 years). Thirty‐eight (61.2%) patients had their colonoscopy performed in another institution. The incidence rate decreased to 0.37 perforations per 1000 colonoscopies within Western Health. Overall, diagnostic colonoscopies accounted for 56% of perforations and perforations were likely to occur in the left colon (P = 0.006). Fifty‐one (82%) patients underwent surgery during their admission, with 24% of these being laparoscopic procedures. An earlier diagnosis was associated with significantly less intra‐abdominal contamination. Gross peritoneal contamination was more likely to be associated with the decision to form a stoma (37%, n = 19, P = 0.04). Thirty‐day mortality was 1.6% (n = 1).

Conclusions

Colonoscopic perforations occur in experienced hands and may have serious implications. We demonstrated a difference in patterns of injury between therapeutic and diagnostic colonoscopies. Those who have an earlier diagnosis are less likely to have severe intra‐abdominal contamination requiring a stoma formation.

Endocuff Vision‐assisted colonoscopy: a randomized controlled trial

March 21, 2019 - 19:35

This is a brief paper looking at the benefit of capped devices for improving the efficiency of colonoscopy. Polyp detection can reduce the incidence of interval colorectal cancer. This is a randomized controlled trial comparing the benefit of Endocuff Vision versus standard colonoscopy.


Background

Adenoma detection rate (ADR) has shown to be an independent predictor, to reduce the rate of interval colorectal cancer. Endocuff Vision is a relatively new device that has shown promise to improve the ADR. The primary objective was to conduct a randomized controlled trial to compare Endocuff Vision‐assisted colonoscopy (EVAC) with standard colonoscopy (SC). The primary outcome of the study is ADR and the secondary outcomes are caecal intubation rate, terminal ileum intubation rate, scope withdrawal time, quality of bowel preparation and adverse events.

Methods

A randomized controlled trial was performed to compare EVAC versus SC. All patients who presented to the endoscopy suite at the Queen Elizabeth Hospital were assessed for eligibility. Patients were recruited from 15 June 2016 to 20 January 2017. A total of 360 patients were included; 40 were excluded. The patients were randomized using block randomization; 138 patients were recruited to SC and 182 to EVAC.

Results

A total of 231 polyps were retrieved during the study period. Polyp detection rate (PDR) was high in both groups: 53% in the EVAC group versus 41.1% in SC. This was statistically significant with a P‐value of 0.035. ADR was similarly high in both groups: 36.81% in EVAC group versus 28.99% in SC group. ADR did not reach statistical significance.

Conclusions

EVAC does improve the PDR. Though the ADR did not reach statistical significance, there is a trend towards improved adenoma detection and there is statistical significance in the overall PDR.

Oncoplastic partial breast reconstruction improves patient satisfaction and aesthetic outcome for central breast tumours

March 21, 2019 - 04:27

Lumpectomy for centrally located tumors has a high risk for breast deformity. Oncoplastic partial breast reconstruction can be done at the time of lumpectomy. It shows clear advantages, both for patient satisfaction and aesthetic outcome.


Background

Patients with centrally located tumours involving the nipple–areolar complex (NAC) who undergo breast‐conserving treatment (BCT) are at high risk for breast deformity and asymmetry. Immediate oncoplastic breast reconstruction (OBR) can have a favourable impact on surgical outcome.

Methods

We retrospectively compared aesthetic outcomes and patient satisfaction among women treated with NAC lumpectomy and immediate OBR with patients treated with BCT alone. Aesthetic outcome was evaluated by independent observers, and patient satisfaction was assessed by the BREAST‐Q questionnaire.

Results

A total of 24 patients were studied, 12 in each group. Demographics and oncological staging were similar in both groups, apart from mean age, hypertension and tumour size/lumpectomy weight. Patients in the OBR group had higher scores for aesthetic outcome and a higher degree of patient satisfaction from the surgical outcome compared to the patients in the BCT‐alone group.

Conclusions

The immediate OBR approach in the treatment of centrally located tumours with NAC resection has clear advantages over BCT alone. This approach should be considered for and offered to suitable patients.

Prognostic impact of the combination of the neutrophil‐to‐lymphocyte ratio and serum carbohydrate antigen 19‐9 in patients with pancreas head cancer

March 20, 2019 - 23:14
Background

This study aimed to evaluate the clinical value of the combination of a traditional prognostic factor with a systemic inflammation‐based prognostic factor in patients undergoing curative resection for pancreas head cancer diagnosed as pancreatic ductal adenocarcinoma.

Methods

From January 2005 to December 2015, 198 patients were enrolled. Various clinicopathological factors potentially associated with survival and recurrence were evaluated in this study.

Results

The selected cut‐off values for the test prognostic factors with sufficient sensitivity and specificity were 2.8 for the neutrophil‐to‐lymphocyte ratio (NLR) and 70 U/mL for serum carbohydrate antigen 19‐9 (CA19‐9). Kaplan–Meier survival analysis demonstrated that the 5‐year survival rate in patients with a high NLR and CA19‐9 was 21.8% compared with 79.8% for patients with a low NLR and CA19‐9. The 5‐year disease‐free survival rate in patients with a high NLR and CA19‐9 was 0% compared with 33.9% for patients with a low NLR and CA19‐9. Patients with high NLRs and high CA19‐9 were more likely to have an early recurrence and multiple relapse patterns.

Conclusion

Preoperative NLR and serum CA19‐9 offer significant prognostic information for survival following curative resection of pancreas head cancer diagnosed as pancreatic ductal adenocarcinoma.

Impact of public–private partnership on a regional colonoscopy service

March 19, 2019 - 22:19

Wait‐times for both specialist outpatient assessment and colonoscopy have been significantly reduced through the introduction of a unique public–private partnership in the Greater Geelong area, resulting in more timely access for public patients and improved compliance with the new guidelines.


Background

A public–private partnership for endoscopy was introduced in Geelong where there was no capacity for public hospital endoscopy lists to expand. This paper presents the impact of this partnership on colonoscopy services.

Methods

Data were collated from prospectively maintained databases. Wait‐times to outpatient appointments, colonoscopy and follow‐up were analysed between July 2015 and June 2017 allowing for a 12‐month period of analysis before and after the initiation of the contract. Data are presented as medians (interquartile range).

Results

A total of 1300 colonoscopies were done between July 2015 and June 2016 compared to 2114 colonoscopies (P < 0.01) after the initiation of the public–private contract; 1073 (51%) colonoscopies were done on private contract. Prior to public–private contract, 41% patients waited more than 120 days from first presentation to healthcare services to diagnostic colonoscopy, this decreased to 19% after. Improvements were seen in both the waiting time for outpatient consultation (reduced from 92 days (39–136) prior to July 2016 to 73 days (32–122); P < 0.01) after) and the time taken from consultation to colonoscopy (from 125 days (70–207) to 36 days (21–159); P < 0.01) for category 1 patients.

Conclusion

Wait‐times for both specialist outpatient assessment and colonoscopy have been significantly reduced through the introduction of a unique public–private partnership in the Greater Geelong area, resulting in more timely access for public patients and improved compliance with new guidelines.

Computed tomography colonography: a retrospective analysis of outcomes of 2 years experience in a district general hospital

March 19, 2019 - 05:55

Computed tomography colonography is as efficacious as optical colonoscopy for colorectal cancer and polyp detection. The rate of colorectal cancer and polyp detection in this study was 2% and 8%, respectively. The rate of biopsy proven cancer was 10% following a suspicious colonogram. With our ageing population, it is acceptable that computed tomography colonography is increasingly used as a first line investigation in select patients.


Background

Colonoscopy is the gold‐standard investigation for direct luminal visualization of the large bowel. Studies have shown the efficacy of computed tomography colonography (CTC) is equivalent to colonoscopy in both cancer and polyp detection.

Methods

A retrospective review of patients undergoing CTC from January 2013 to October 2014 was performed. Patient demographics, indication for investigation, computed tomography findings, optical colonoscopy findings and histology results were recorded.

Results

Seven hundred and fifty‐eight CTC were performed. Three hundred and seventeen patients were male (42%) and 441 (58%) were female. Endoscopy was advised in 209 cases. One hundred and twenty (16%) were deemed suspicious for cancer of whom 96 (80%) had optical colonoscopy. A total of 12 colorectal cancers were detected. Potential polyps were noted in 58 cases (8%). Forty‐four patients underwent endoscopy (75%) and 17 polyps confirmed (38%). Two patients had foci of invasive cancer histologically. Significant extracolonic findings were identified in 60%, including five cases of gastric carcinomas. The most common other findings were gallstones and hernias.

Conclusion

The rate of colorectal cancer detection in this study was 2%. The rate of biopsy proven cancer was 10% following a suspicious colonogram. Endoscopic correlation was not obtained in 20% of cases of radiological suspicion. CTC is as efficacious as optical colonoscopy for colorectal cancer and polyp detection.

Severe opioid toxicity following rupture of an ingested drug balloon in a body packer

March 19, 2019 - 05:02
ANZ Journal of Surgery, EarlyView.

Open reduction through a posterior incision in the surgical treatment of shoulder posterior dislocation associated with proximal humeral fractures

March 19, 2019 - 02:30

The dislocated humeral head can be reduced through a posterior approach, while fractures can be reduced and fixed through a deltopectoral approach. This technique has the advantages of simplicity and its minimally invasive approach for reducing the dislocation.


Background

We explored the surgical technique of reducing the humeral head and repairing the fractures through a combined approach in the treatment of this complex injury.

Methods

Six patients with posterior shoulder dislocations associated with proximal humerus fractures were enrolled in this study. The posteriorly dislocated head was first reduced through a shoulder posterior incision and the ruptured posterior capsular tissues were repaired simultaneously using a suture anchor. The fractures were then reduced and fixed with a PHILOS through a deltopectoral approach. The affected shoulders were immobilized in a neutral position for 6 weeks postoperatively with a customized orthosis and then permitted active shoulder exercises after removal of the orthosis. At the last visit, union of the fractures was evaluated. Degrees of anterior forward of the affected shoulder were recorded. Outcomes were evaluated according to UCLA and Constant criteria.

Results

Six patients were followed up for an average of 24.5 ± 7.4 (range 13–35) months. At the last visit, the mean degree of anterior forward was 171.7 ± 7.5 (range 160–180) degrees. An average of 32.9 ± 1.2 (range 31–34) points was obtained according to UCLA criteria, demonstrating excellent and good results in two and four cases, respectively. The mean Constant score was 87.3 ± 4.1 (range 83–92) points.

Conclusions

The dislocated humeral head can be reduced through a posterior approach, while fractures can be reduced and fixed through a deltopectoral approach. This technique has the advantages of simplicity and its minimally invasive approach for reducing the dislocation.

Management of per rectal bleeding is resource intensive

March 19, 2019 - 02:29

The management of patients with PR bleeding is resource intensive. Better identification and allocation of resources in patients who present with PR bleeding may lead to better efficiency in managing this growing clinical problem.


Background

Haematochezia or per rectal (PR) bleeding is the most common presentation of lower gastrointestinal bleeding. This study analyses the hospital resources used in the management of patients with PR bleeding.

Methods

A retrospective analysis was performed on patients who presented with PR bleeding from June 2012 to December 2013 to a single tertiary centre in Sydney, Australia. Age, gender, comorbidities, use of antiplatelet or anticoagulant medications, vital signs, and haematological data were recorded. The objective factors available on initial patient assessment were analysed for their relationship with the following outcomes: use of computed tomography mesenteric angiogram, formal angiography and embolization, transfusion of blood products, endoscopy, operative management and length of stay.

Results

There were 523 confirmed presentations of PR bleeding. Four hundred and fifty‐two of these presented directly to emergency department, while 71 were referred from another hospital. One in five patients had blood transfusion (19%), 13% had computed tomography mesenteric angiogram, 4% had embolization and 13% underwent diagnostic and/or therapeutic colonoscopy. Patients referred from other facilities were more comorbid (55% versus 30%), more likely to be on antiplatelet or anticoagulant (69% versus 33%) with a higher rate of embolization (28% versus 4%), more packed cell transfusions (2.1 versus 0.7 units) and longer length of stay (7.9 versus 5.7 days) but mortality was the same (1%).

Conclusions

The management of patients with PR bleeding is resource intensive. Better identification and allocation of resources in patients who present with PR bleeding may lead to better efficiency in managing this growing clinical problem.

Initial single institution experience with robotic biliary surgery and bilio‐enteric anastomosis in southeast Asia

March 19, 2019 - 02:29

Our initial experience demonstrated that robotic major biliary surgery can be adopted safely with a low open conversion rate. Robotically constructed bilio‐enteric anastomosis can be performed safely with a low anastomotic complication rate.


Background

Presently, experience with robotic biliary surgery (RBS) is increasing worldwide although widespread adoption remains limited. In this study, we report our initial experience with RBS.

Methods

Retrospective review of a single institution prospective database of 95 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2018. Of these, 27 patients who underwent RBS were included in this study. RBS was performed by three principal console surgeons of whom one surgeon performed 23 (85%) and supervised all cases. Additionally, to evaluate our initial outcomes with bilio‐enteric anastomoses, eight consecutive pancreatoduodenectomies were included.

Results

Of the 27 RBS performed, these included 10 hepaticojejunostomies with bile duct resections (including two concomitant pancreatoduodenectomies and one right hepatectomy) for choledochal cysts, bile duct strictures and biliary malignancies; five liver resections with hilar lymph node clearance for gallbladder cancer; four for Mirizzi syndrome; two cholecystectomies with cholecystoenteric fistula and two bile duct exploration after failed endoscopic treatment of choledocholithiasis. There were no open conversions, no 90‐day mortality and four (14.8%) major (>Grade II) morbidities. The median post‐operative stay was 6 (range 1–29) days and there was one (3.7%) 30‐day readmissions. Of our first 18 robotically constructed bilio‐enteric anastomoses, there was only one (5.5%) early anastomotic complication (bile leak requiring reoperation).

Conclusion

Our initial experience demonstrated that RBS can be adopted safely with a low open conversion rate. Robotically constructed bilio‐enteric anastomosis can be performed safely with a low anastomotic complication rate.

Is Norton Score a useful tool for identifying high‐risk patients prior to emergency surgery?

March 19, 2019 - 01:11

Emergency surgery in elderly patients is associated with high mortality rates. Various scoring systems may be valuable to predict mortality and morbidity rates. It has lately been suggested that the Norton Score could be used to indirectly quantify frailty.


Background

Emergency surgery in elderly patients is associated with high mortality rates. Various scoring systems may be valuable in predicting mortality and morbidity rates. It has been suggested that the Norton Score (NS) could be used to quantify frailty. We hypothesized that NS could be a useful tool for identifying high‐risk patients before emergency/urgent surgeries.

Methods

A retrospective study was conducted in the Department of Surgery at Kaplan Medical Center, Rehovot, Israel. Inclusion criteria: age ≥50 years, American Society of Anesthesiologists (ASA) physical status score ≥3 and urgent/emergency laparotomy. A total of 400 patients were identified, and 150 (37.5%) matched the inclusion criteria.

Results

A total of 150 patients with ASA scores of 3–5 and who underwent emergent/urgent laparotomy from 1 January 2011 through 31 January 2013 were included. Mean age was 77 ± 9.7 years. The mortality rate at 1 month was 44% (66 patients) and at 1 year was 54.7% (82 patients). A higher ASA score was significantly associated with mortality (P < 0.001). Survivors had lower frailty scores and presented significantly higher preoperative NS (Modified Frailty Index 2.45 versus 3.06, P < 0.05; NS 16.09 versus 12.94, P < 0.01). Preoperative NS was the most significant variable that predicted poor patient prognosis (odds ratio 0.84; 95% confidence interval 0.73–0.96). For ASA 3 and ASA 4, the grade of daily personal independence in activities showed a positive correlation with survival (P < 0.001).

Conclusion

NS can be a very useful and quick tool to evaluate surgical risk in emergency surgery. Our study supports the use of NS in the perioperative evaluation prior to emergency surgery.

Lateral bone flap approach for displaced intra‐articular calcaneus fractures

March 14, 2019 - 23:12

We proposed a new approach named the lateral bone flap approach for displaced intra‐articular calcaneus. This approach is simple, safe and effective.


Background

The traditional extended lateral approach for calcaneus fractures can provide sufficient exposure for reduction, but complications are frequent. The minimally invasive approach does limited damage to the soft tissue and its complication rate is low, but provides limited surgical exposure for complicated fracture. Thus, an approach that could provide wide exposure with less soft tissue injury is important.

Methods

The lateral bone flap approach, we proposed, involved the same incision as the extended lateral approach. After incision, osteotomy was performed around the lateral bulged wall of the calcaneus without dissection of soft tissue. The lateral wall was free from calcaneus and connected with the soft tissue, and the lateral bone flap was developed. The reduction of fracture and the fixation of plate were performed as usual. Next, the bone flap was reduced and sutured. This retrospective study of lateral bone flap approach included 63 cases of 58 patients with displaced intra‐articular calcaneus fractures from January 2011 to January 2015. Clinical and radiological outcomes and complications were all recorded.

Results

Radiological outcome was significantly improved at 3 months and 2 years post‐operatively compared with that of pre‐operatively (P < 0.01). The Maryland Foot Score at the last follow up was 87.2 ± 7.0. The excellent/good rate was 90.5%. One case of delayed wound healing occurred. No infection or sural nerve injury occurred.

Conclusion

The lateral bone flap approach is simple, safe and effective for displaced intra‐articular calcaneus.

Long‐term oncological outcomes of single‐port laparoscopic surgery for colon cancer

March 14, 2019 - 23:10

Single‐port laparoscopic colectomy can be applied to the treatment of colon cancer with good long‐term oncological outcomes.


Background

We retrospectively reviewed our consecutive experience from the introduction of single‐port laparoscopic surgery (SPS) for colon cancer, and its 5‐year oncological outcomes are evaluated.

Methods

A total of 288 patients (140 males) with a mean age of 71.5 years were treated with the single‐port laparoscopic colectomy for stage I, II and III colon cancers. Exclusion criteria of SPS were patients with unresolved bowel obstruction, T4b tumour, tumour perforation and severe medical illness.

Results

In 20 patients (6.9%), we inserted an extra port mainly to transect the rectum. The median follow‐up period was 52 months. The 5‐year relapse‐free survival rates in stage I, II and III patients were 95.8%, 80.2% and 61.6%, respectively. The 5‐year overall survival rates for stage I, II and III patients were 97.4%, 85.3% and 72.9%, respectively. The 5‐year cancer‐specific survival rates in patients diagnosed pathologically T1, T2, T3 and T4 were 100%, 100%, 92.1% and 73.9%, respectively.

Conclusions

SPS colectomy can be applied to the treatment of colon cancer with good long‐term oncological outcomes. However, we should pay more attention when we treat the pathologically diagnosed T4 tumours.

Femoral side‐only revision options for the Birmingham resurfacing arthroplasty

March 14, 2019 - 23:10

Investigation of compatible dual mobility femoral stems to be used with the stable acetabular component of a Birmingham hip resurfacing system in the context of revision where only the femoral component has failed. This is based on appropriate sizing generating satisfactory clearance (the contact distance between the femoral head and acetabular shell that allows functional lubrication). Such compatibility would mean avoidance of acetabular shell revision and considerably less operative burden.


Background

The Birmingham Hip Resurfacing (BHR) system (Smith and Nephew) was developed as an alternative to conventional total joint replacement for younger, more active patients. Among other complications exists the risk for femoral component failure. The only marketed revision option for such a complication involves exchange of all components for a total replacement arthroplasty. This presents as a considerable and potentially unnecessary operative burden where revision of only the femoral prosthesis would suffice. We have analysed revision options for BHR in the context of periprosthetic femoral fractures with a stable acetabular component.

Methods

Technical details of dual mobility hip systems available in Australia were collated and analysed to assess for potential ‘off label’ use with an existing BHR acetabular component. These data were then compared with the custom‐made Smith and Nephew dual mobility implant with respect to clearance and sizing.

Results

Two dual mobility articulation modalities from two companies were identified as appropriate for potential usage with four products analysed in detail. These two demonstrated acceptable sizing and clearance measurements.

Conclusion

Comparison between readily available dual mobility prostheses with custom‐made implants showed off label dual mobility prosthetic use to be a viable alternative for femoral‐only revisions with in situ BHR. Single component revision has several advantages which include: a less complex surgical procedure, shorter operative time, decreased blood loss and the expectation of resultant lower morbidity. Furthermore, this less complex revision surgery should give comparable results to that of primary total hip arthroplasty.

Diagnostic laparoscopy in penetrating abdominal trauma

March 14, 2019 - 23:09

This article summarizes the treatment of patients with penetrating anterior abdominal injuries without an indication for immediate laparotomy. The accuracy of diagnostic laparoscopy in identifying peritoneal breach was 100%.


Background

Penetrating abdominal trauma is uncommon in Australia. There are multiple potential approaches to the patient without an indication for immediate laparotomy. This study examined the management of patients with a penetrating anterior abdominal injury in a Level 1 trauma centre, and in particular investigated the outcomes of those patients who underwent diagnostic laparoscopy.

Methods

A retrospective review was undertaken of all patients presenting to a Level 1 trauma centre with an anterior abdominal stab wound over a 15‐year period. Patient demographic, injury, examination, treatment and outcome data were extracted. These data were analysed using SPSS PASW version 20.

Results

A total of 318 patients were identified. Immediate laparotomy was performed in 121 of those patients. Of the remaining 197 patients, 146 underwent diagnostic laparoscopy. Peritoneal breach was identified in 87 patients, 79 of whom then had exploratory laparotomy. The laparotomy was therapeutic in 36 of 79 patients (45.6%). Multiple stab wounds were an independent predictor of therapeutic laparotomy (hazard ratio 2.39, 95% CI 1.16–4.93). Diagnostic laparoscopy was 100% sensitive, 60.9% specific and had a negative predictive value of 100% and a positive predictive value of 40%. Non‐therapeutic laparotomy was associated with a median length of stay of 5.5 days and a complication rate of 9.3%.

Conclusion

Diagnostic laparoscopy to detect peritoneal breach is a safe approach in the management of anterior abdominal stab wounds. However, utilizing peritoneal breach as an indication for laparotomy is associated with a moderate incidence of non‐therapeutic laparotomy. Measures to decrease the negative laparotomy rate should be considered.

Perforated cytomegalovirus pseudotumour

March 13, 2019 - 05:48
ANZ Journal of Surgery, EarlyView.

Prevalence and clinical significance of regional lymphadenectomy in patients with hepatocellular carcinoma

March 11, 2019 - 21:45

Our study aims to explore regional lymphadenectomy rate, node‐positive rate, as well as their clinicopathologic relevance and prognostic value in patients with hepatocellular carcinoma receiving liver resection and liver transplantation. Compared with liver resection group, liver transplantation patients seemed to receive more un‐selected regional lymphadenectomy, and regional lymphadenectomy played no part in improving prognosis of the whole or any subgroup. A more selective strategy should be set up for LT patients, which starved for further studies to ameliorate.


Background

A limited amount of literature involves the clinical significance of regional lymphadenectomy during operations on hepatocellular carcinoma (HCC) patients. Our study aims to explore regional lymphadenectomy rate and node‐positive rate, as well as their clinicopathological relevance and prognostic values in patients with HCC receiving liver resection (LR) and liver transplantation (LT).

Methods

Patients with HCC who received LR or LT and were diagnosed from 2004 to 2013 were retrieved from the Surveillance Epidemiology and End Results (SEER) database. A total of 6367 patients with staging and regional lymphadenectomy information was included.

Results

The regional lymphadenectomy rates were 14.3% and 28.6% in patients receiving LR and LT, respectively. Additionally, the rate of LT patients increased from 21.3% to 33.3% in the 2004–2013 time period. In patients with regional lymphadenectomy, node‐positive rates were 8.4% and 0.9% in LR and LT patients, respectively. Regional lymphadenectomy was conducted relatively non‐specifically in patients receiving LT compared with those receiving LR by analysing its clinicopathological relevance. Furthermore, regional lymphadenectomy did not improve prognosis in the general population or any subgroup.

Conclusion

There was a disparity between high regional lymphadenectomy rate and extremely low node‐positive rate in patients with HCC receiving LT, which requires further improvement in future clinical practice.