RESUMO
BACKGROUND: The Delphi consensus study was carried out under the auspices of the International and Asia-Pacific Hepato-Pancreato-Biliary Associations (IHPBA-APHPBA) to develop practice guidelines for management of gallbladder cancer (GBC) globally. METHOD: GBC experts from 17 countries, spanning 6 continents, participated in a hybrid four-round Delphi consensus development process. The methodology involved email, online consultations, and in-person discussions. Sixty eight clinical questions (CQs) covering various domains related to GBC, were administered to the experts. A consensus recommendation was accepted only when endorsed by more than 75% of the participating experts. RESULTS: Out of the sixty experts invited initially to participate in the consensus process 45 (75%) responded to the invitation. The consensus was achieved in 92.6% (63/68) of the CQs. Consensus covers epidemiological aspects of GBC, early, incidental and advanced GBC management, definitions for radical GBC resections, the extent of liver resection, lymph node dissection, and definitions of borderline resectable and locally advanced GBC. CONCLUSIONS: This is the first international Delphi consensus on GBC. These recommendations provide uniform terminology and practical clinical guidelines on the current management of GBC. Unresolved contentious issues like borderline resectable/locally advanced GBC need to be addressed by future clinical studies.
RESUMO
BACKGROUND/AIMS: There has been an increase in the incidence of neoplasms of the liver in recent years, although there is still a fear of performing aggressive surgical procedures in elderly patients, especially regarding hepatic surgery. The objective of this study was to analyse the influence of age on the morbidity and mortality of patients undergoing hepatic resection. METHODOLOGY: This was a study of 414 patients who underwent 447 hepatic resections between November 1993 and December 2010. The patients were divided into two groups according to whether they were ≤ 65 or > 65 years of age. RESULTS: The elderly group included 113 resections, while the young group was composed of 334 procedures. The elderly group had more malignant lesions and more comorbidities. With regard to the transoperative and post-operative data, the two groups displayed similar results. According to the multivariate analysis, cirrhosis and the use of transoperative pedicular clamping were independent predictors of morbidity. Cirrhosis was also an independent predictor of mortality. CONCLUSIONS: The results indicate that age is not a predisposing factor for the worsening of results of hepatic resection in selected patients, especially with regard to cirrhosis. Moreover, surgeons must avoid the use of transoperative pedicular clamping.