The efficacy of transarterial chemoembolization in downstaging unresectable hepatocellular carcinoma to curative therapy: a predicted regression model.

Patients with hepatocellular carcinoma (HCC) outside Milan criteria (MC) may be candidates for curative therapy after successful downstaging. We aimed to identify the predictors of successful downstaging of unresectable HCC in patient by transarterial chemoembolization (TACE) outside MC. We performed a retrospective study on patients with unresectable HCC outside MC who received downstaging with TACE. Clinical and laboratory variables were recorded. We identified 101 patients with unresectable HCC who underwent initial TACE, who formed the derivation set of this study. Thirty patients who treated by TACE with the same selection criteria served as an external validation set. We performed univariate and multivariate logistic regression analyses to identify variables associated with successful downstaging. Then we did the predictive model to predict the efficiency of TACE. Of the 101 patients in the study, 26 patients (25.7%) were successfully downstaging and 75 patients (74.3%) failed downstaging. Multivariate analysis of factors to predict successful downstaging of HCC outside MC the number of tumor (P = 0.01), portal vein tumor thrombosis (PVTT)(p < 0.01), the size of tumor (P = 0.02), hepatitis B surface antigen (HBsAg) (P = 0.01), α-fetoprotein (AFP) (P = 0.02) as significant predictors of successful downstaging. Then we constructed the predictive model. The area under the ROC curve (AUROC) of the predictive equation was 0.90 (95% confidence interval, 0.83-0.95). We found in our study that the number and size of tumors, PVTT, HBsAg, and AFP are good predictors of successful downstaging of unresectable HCC in patients by TACE outside the MC.

Comparative outcomes of single-incision laparoscopic, mini-laparoscopic, four-port laparoscopic, three-port laparoscopic, and single-incision robotic cholecystectomy: a systematic review and network meta-analysis.

Benign gallbladder diseases are common in surgery department, and the laparoscopic cholecystectomy (LC) is the gold standard procedure for benign diseases of gallbladder. Laparoscopic cholecystectomy is conventionally performed using four laparoscopic ports. However, the clinical application of different LCs is equivocal and there is no comprehensive comparison to explore which surgical options could benefit patients with benign gallbladder diseases. A network meta-analysis (NMA) to evaluate the efficacy of the different LCs could benefit patients with benign gallbladder diseases by comprehensive comparison. A systematic literature search was performed using PubMed, Embase, and Cochran Library. Totally, 17 randomized controlled trials (RCTs) (n = 1627) met study selection criteria and were incorporated in this NMA study. The first ranking probabilities of the five surgical options to alleviate postoperative pain scores were: 54.4% for single-incision robotic cholecystectomy (SIRC), 25.2% for single-incision laparoscopic cholecystectomy (SALC), and 24.9% for mini-laparoscopic cholecystectomy (Mini). The first ranking probabilities for reducing postoperative complications in the surgical options were: 61.3% for three-port laparoscopic cholecystectomy and 21.8% for four-port laparoscopic cholecystectomy. The first ranking probabilities for reducing hospital stay(days) in the surgical options were: 32.3% for SIRC, 29.0% for three-port laparoscopic cholecystectomy and 19.8% for four-port laparoscopic cholecystectomy. The first ranking probabilities for reducing operation time showed that the three-port technique had the shortest operation time, followed by three-port laparoscopic cholecystectomy (51.3%), four-port laparoscopic cholecystectomy (26.8%), and mini-laparoscopic cholecystectomy (21.6%). Our study found that the optimal surgical plan for different outcomes varies, making it difficult to give a comprehensive recommendation. Three-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy may be the best options in terms of reducing surgical complications and operative time. Meanwhile, SIRC is the best options for relieving postoperative pain relief. SIRC and three-port laparoscopic cholecystectomy can reduce hospital stay (days) compared other LCs.

Xanthogranulomatous inflammation involving the gallbladder, bile duct, and pancreas: a case report.

Xanthogranulomatous inflammation (XGI) is a rare, benign condition that can affect several organs, including the gallbladder, kidney, skin, gastrointestinal tract, lymph nodes, and soft tissues. It is often misdiagnosed as a malignancy. In this report, we present the case of a 79-year-old male who presented with persistent jaundice for 11 months. Computed tomography and magnetic resonance imaging revealed pancreatic head enlargement, gallbladder thickening, and common bile duct thickening, leading to a preoperative diagnosis of malignant neoplasm of the pancreatic head. During surgery, dense adhesions were found around the portal vein, suggestive of mass invasion. To relieve obstruction, choledochojejunostomy was performed. Postoperative pathological examination revealed xanthogranulomatous cholecystitis (XGCc), xanthogranulomatous cholangitis (XGCg), and xanthogranulomatous pancreatitis (XGP). XGI affecting the bile ducts and pancreas is extremely rare, and there are no reported cases of simultaneous involvement of the gallbladder, bile duct, and pancreas by XGI. This study provides valuable insight into the differential diagnosis of XGI by presenting the imaging features of XGI patients.

The clinical effectiveness of wound edge protectors in reducing surgical site infection after abdominal surgery: meta-analysis.

BACKGROUND: Surgical site infection (SSI) is a common complication after abdominal surgery. The effectiveness of wound edge protectors in reducing infection of the surgical sites is still unclear. The purpose of this study was to determine the clinical effectiveness of a wound edge protector (WEP) in reducing SSI rates after abdominal surgery. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched to obtain relevant articles published up to September 2021. Publications were retrieved if they contain primary data on the use of WEPs in reducing SSI compared with standard care in patients undergoing abdominal surgery. Subgroup analyses were performed for different WEP types, surgical sites, and levels of contamination. The outcome of interest was a clinically defined SSI. Qualitative variables were pooled using risk ratios (RRs). RESULTS: Twenty-two eligible randomized clinical trials involving 4492 patients were included in this meta-analysis. WEP was associated with the reduced incidence of overall SSI (RR = 0.66; 95 per cent c.i. 0.53 to 0.83; P = 0.0003), and superficial SSI (RR = 0.59; 95 per cent c.i. 0.38 to 0.91; P = 0.02). In addition, WEP also successfully reduced the risk of SSI in clean-contaminated wounds (RR = 0.61; 95 per cent c.i. 0.40 to 0.93; P = 0.02) as well as in contaminated wounds (RR = 0.47; 95 per cent c.i. 0.33 to 0.67; P < 0.0001); however, WEP did not reduce SSI incidence in colorectal surgery (RR = 0.68; 95 per cent c.i. 0.46 to 1.01; P = 0.05). CONCLUSION: This study suggests that WEP was efficient in reducing superficial SSI. Both double-ringed and single-ringed devices were efficient in reducing SSI. WEP was effective in reducing SSI incidence in clean-contaminated and contaminated surgery; however, its use does not reduce the SSI rate in colorectal surgery.

Detection of the common bile duct in difficult bile duct exploration using indocyanine green fluorescence imaging: A case report.

We describe two cases using indocyanine green (ICG) fluorescence imaging for visualization of the common bile duct (CBD) in patients with difficult Bile duct exploration (BDE) due to extensive dense adhesions around the hepatoduodenal ligament. The CBD was rapidly detected under fluorescence guidance without excessive dissection of extensive dense adhesions. It is illustrated that the use of ICG fluorescence imaging is effective and feasible for detecting the CBD and thus we highly recommend this method during difficult BDE.