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1.
World J Surg ; 45(10): 2964-2974, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34269842

RESUMO

BACKGROUND: The Enhanced Recovery After Surgery (ERAS) society published new recommendations for hepatectomy in 2016. Few studies have assessed their clinical impact. The aim of this monocentric study was to assess the impact of those guidelines on outcomes after liver surgery with a special focus on cirrhotic patients. METHOD: Postoperative outcomes of patients undergoing hepatectomy 30 months before and after ERAS implementation according to the 2016 ERAS guidelines were compared after inverse probability of treatment weighting (IPTW). Primary endpoint was 90-day morbidity. RESULTS: From 2015 to 2020, 430 patients underwent hepatectomy including 226 procedures performed before and 204 after ERAS implementation. After IPTW, overall morbidity (42.5% vs. 64.7%, p < 0.001), Comprehensive Complication Index (CCI) score (14.3 vs. 20.8, p = 0.004), length of stay (10.4 vs. 13.7 days, p = 0.001) and textbook outcome (50% vs. 40.2%, p = 0.022) were significantly improved in the ERAS group, while mortality and severe complications were similar in both groups. In the non-cirrhosis subgroup (n = 321), these results were confirmed. However, in the cirrhosis subgroup (n = 105), no difference appeared on outcomes after hepatectomy with an overall morbidity (47.5% vs. 65.2%, p = 0.069) and a length of stay (8 vs. 9 days, p = 0.310) which were not significantly different. The compliance rate to ERAS guidelines was 60% in both cirrhotic and non-cirrhotic subgroups. CONCLUSION: Perioperative ERAS program for hepatectomy results in improved outcomes with decreased rate of non-severe morbidity. Although those guidelines are not deleterious for cirrhotic patients, they probably require revisions to be more effective in this patient population.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Hepatectomia , Humanos , Tempo de Internação , Cirrose Hepática/complicações , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
2.
J Hepatol ; 68(6): 1172-1180, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29410287

RESUMO

BACKGROUND & AIMS: No-touch multibipolar radiofrequency ablation (NTM-RFA) represents a novel therapy that surpasses standard RFA for hepatocellular carcinoma (HCC), but it has not been compared to surgical resection (SR). We aimed to compare the outcomes of NTM-RFA and SR for intermediate-sized HCC. METHODS: Between 2012 and 2016, 141 patients with solitary HCC ranging from 2 to 5 cm were treated by NTM-RFA or SR at a single-center. The outcomes of 128 patients were compared after using inverse probability of treatment weighting (IPTW). RESULTS: Seventy-nine patients had NTM-RFA and 62 had SR. After IPTW, the two groups were well-balanced for most baseline characteristics including tumor size, location, etiology, severity of underlying liver disease and alpha-fetoprotein level. Morbidity was higher (67.9% vs. 50.0%, p = 0.042) and hospital stay was longer (12 [IQR 8-13] vs. 7 [IQR 5-9] days, p <0.001) after SR. Local recurrence rates at one and three years were 5.5% and 10.0% after NTM-RFA and 1.9% and 1.9% after SR, respectively (p = 0.065). The rates of systematized recurrence (within the treated segment or in an adjacent segment within a 2 cm distance from treatment site) were higher after NTM-RFA (7.4% vs. 1.9% at one year, 27.8% vs. 3.3% at three years, p = 0.008). Most patients with recurrence were eligible for rescue treatment, resulting in similar overall survival (86.7% after NTM-RFA, 91.4% after SR at three years, p = 0.954) and disease-free survival (40.8% after NTM-RFA, 56.4% after SR at three years, p = 0.119). CONCLUSION: Compared to SR, NTM-RFA for solitary intermediate-sized HCC was associated with less morbidity and more systematized recurrence, while the rate of local recurrence was not significantly different. Most patients with intrahepatic recurrence remained eligible for rescue therapies, resulting in equivalent long-term oncological results after both treatments. LAY SUMMARY: Outcomes of patients treated for intermediate-sized hepatocellular carcinoma by surgical resection or no-touch multibipolar radiofrequency ablation were compared. No-touch multibipolar radiofrequency ablation was associated with a lower overall morbidity and a higher rate of systematized recurrence within the treated segment or in an adjacent segment within a 2 cm distance from the initial tumor site. Most patients with intrahepatic recurrence remained eligible for rescue curative therapy, enabling them to achieve similar long-term oncological results after both treatments.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência/métodos , Idoso , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Feminino , França/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/terapia , Modelos de Riscos Proporcionais , Ablação por Radiofrequência/efeitos adversos
3.
Obes Surg ; 28(1): 285-289, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29103071

RESUMO

Morbid obesity in adolescents has been treated effectively with laparoscopic adjustable gastric banding (LAGB). We prospectively studied 97 consecutive obese adolescents undergoing LAGB over the course of 10 years. The average patient age at surgery was 17.2 ± 0.7 years; mean body mass index, 44.9 ± 6.1 kg/m2. Excluding those lost to follow-up (n = 21), respective mean total weight loss and excess weight loss were 20.0 ± 16.6 and 46.6 ± 39.5% (n = 76, 78.4%). An ascending trend line showed a significant positive correlation between excess weight loss and follow-up duration (mean 56.0 ± 22.0 months). There was no mortality or morbidity. Nineteen patients (25.0%) underwent band removal at a mean 43.0 ± 28.0 months. LAGB proved safe and effective over the mid- and longer term; it should be strongly considered as a procedure of first intention for obese adolescents.


Assuntos
Gastroplastia , Obesidade Mórbida/cirurgia , Obesidade Infantil/cirurgia , Adolescente , Índice de Massa Corporal , Feminino , Seguimentos , Gastroplastia/efeitos adversos , Gastroplastia/métodos , Humanos , Laparoscopia/métodos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Redução de Peso
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