Textbook outcomes in liver surgery for gallbladder cancer patients treated with curative-intent resection: a multicenter observational study.

BACKGROUND: Cholecystectomy, hepatectomy, and lymphadenectomy are recommended as the curative treatment for resectable gallbladder cancer (GBC). Textbook outcomes in liver surgery (TOLS) is a novel composite measure that has been defined by expert consensus to represent the optimal postoperative course after hepatectomy. This study aimed to determine the incidence of TOLS and the independent predictors associated with TOLS after curative-intent resection in GBC patients. METHODS: All consecutive GBC patients who underwent curative-intent resection between 2014 and 2020 were enrolled from a multicenter database from 11 hospitals as the training and the internal testing cohorts, and Southwest Hospital as the external testing cohort. TOLS was defined as no intraoperative grade greater than or equal to 2 incidents, no grade B/C postoperative bile leaks, no postoperative grade B/C liver failure, no 90-day postoperative major morbidity, no 90-day readmission, no 90-day mortality after hospital discharge, and R0 resection. Independent predictors of TOLS were identified using logistic regression and were used to construct the nomogram. The predictive performance was assessed using the area under the curve and calibration curves. RESULTS: TOLS was achieved in 168 patients (54.4%) and 74 patients (57.8%) from the training and internal testing cohorts, and the external testing cohort, respectively. On multivariate analyses, age less than or equal to 70 years, absence of preoperative jaundice (total bilirubin≤3 mg/dl), T1 stage, N0 stage, wedge hepatectomy, and no neoadjuvant therapy were independently associated with TOLS. The nomogram that incorporated these predictors demonstrated excellent calibration and good performance in both the training and external testing cohorts (area under the curve: 0.741 and 0.726). CONCLUSIONS: TOLS was only achieved in approximately half of GBC patients treated with curative-intent resection, and the constructed nomogram predicted TOLS accurately.

Surgical management of liver diseases invading the hepatocaval confluence based on IH classification: The surgical guideline in our center.

AIM: to investigate the short-term outcomes and risk factors indicating postoperative death of patients with lesions adjacent to the hepatocaval confluence. METHODS: We retrospectively analyzed 54 consecutive patients who underwent hepatectomy combined with inferior vena cava (IVC) and/or hepatic vein reconstruction (HVR) from January 2012 to January 2016 at our liver surgery center. The patients were divided into 5 groups according to the range of IVC and hepatic vein involvement. The patient details, indications for surgery, operative techniques, intra- and postoperative outcomes were compared among the 5 groups. Univariate and multivariate analyses were performed to explore factors predictive of overall operative death. RESULTS: IVC replacement was carried out in 37 (68.5%) patients and HVR in 17 (31.5%) patients. Type I2H2 had the longest operative blood loss, operative duration and overall liver ischemic time (all, P < 0.05). Three patients of Type I3H1 with totally occluded IVC did not need IVC reconstruction. Total postoperative morbidity rate was 40.7% (22 patients) and the operative mortality rate was 16.7% (9 patients). Factors predictive of operative death included IVC replacement (P = 0.048), duration of liver ischemia (P = 0.005) and preoperative liver function being Child-Pugh B (P = 0.025). CONCLUSION: IVC replacement, duration of liver ischemia and preoperative poor liver function were risk factors predictive of postoperative death. We should be cautious about IVC replacement, especially in Type I2H2. For Type I3H1, it was unnecessary to replace IVC when the collateral circulation was established.

[Remote sensing analysis of forest resources characteristics in main ecological restoration counties in the Three-gorge area based on the 2nd-class inventory data].

Based on high-resolution SPOT-5 images, combined with topographic (1:10000) calculating terrain-bit index, the distribution characteristics of woodlands in different terrain niches, and the buffer radii of different roads, water bodies and settlements were identified by using ArcGIS space overlay and buffer analysis function. Results showed that woodland resources were abundant, and arbor woodland and shrub land were the main species, which mainly distributed in two mountain areas (Fangdou Mountain, Qiyao Mountain) affected by topographic restriction and woodland natural basis. The woodland terrain niche distribution index showed an overall upward trend with increasing terrain niche gradient, especially for the arbor woodland and shrub land, while the other woodland types presented an opposite trend. The percentage of woodland area occupying the corresponding buffer radius around the roads, waterbodies and settlements had a strong similarity with the woodland terrain niche distribution index. Only around the settlements, bamboo forest, sparse woodland and immature woodland occupied higher percentages of the woodland area of the corresponding buffer radius than that of arbor woodland and shrub land. Woodland distribution was mainly controlled by large landform patterns of mountain features, while the distribution of woodlands in the different terrain niches and the different buffer radii of roads, waterbodies and settlements were driven mainly by duress of human activities under the auspices of the large landform patterns.