BACKGROUND:An international registry on liver venous deprivation (LVD, simultaneous portal and hepatic vein embolization) was created in 2020. This study assessed the outcomes after LVD in patients included in the registry. METHODS:Eight international centers participated. Future liver remnant (FLR) and standardized FLR ratios were defined as FLR/total functional liver volume and FLR/total estimated liver volume. RESULTS:216 patients were included (80 women, median age 63). Main surgical indication was colorectal metastases (n=124). Median and standardized FLR ratios before LVD were 33% (IQR27-47) and 32% (IQR24-39). In one patient, right hepatic vein embolization failed. Complications after LVD occurred in 14 patients (6.5%). After LVD, median and standardized FLR ratios significantly increased to 46% (IQR38-60, p<0.001) and 44% (IQR35-51, p<0.001), corresponding to a median kinetic growth rate of 3.4%/week (IQR1.5-6.0). Hepatectomy was performed in 160 patients (72 extended hepatectomies), while 56 dropped out (4% insufficient hypertrophy, 13% tumor progression). Seventy-seven patients had postoperative complications (48%; 5 postoperative liver failures, 3%). Median Comprehensive Complication Index was 20.9 (IQR0-30.8). CONCLUSION:Preliminary data of this international registry showed that LVD had a high technical success rate with few post-procedural complications and significant kinetic growth. Major hepatectomy after LVD appeared to be safe.

Abstract Background Liver venous deprivation (LVD) is a recently developed method to reach maximal liver hypertrophy before major hepatectomy. LVD combines simultaneous portal and ipsilateral hepatic vein embolization. An international registry was created in 2021. Aims This study aimed to describe the outcomes after LVD of patients included in the registry. Methods Since its creation, 7 international expert HPB centers participated to the registry. Preoperative characteristics, data on liver regeneration after LVD, and postoperative results after hepatectomy were collected. Future liver remnant (FLR) and standardized FLR ratios were defined as FLR/total functional liver volume and FLR/total estimated liver volume. Results A total of 191 patients were included (71 women). Median age was 63 (IQR 53-69) and body-mass index 24.8 kg/m2 (IQR 22.3-28.7). Fifty-three patients were ASA III/IV. Main surgical indication was colorectal metastases (n=116). Median FLR and standardized FLR ratios before LVD were 33% (IQR 26-47) and 32% (IQR 23-39). Median time for the LVD procedure was 122 minutes (IQR 99-164). In one patient right hepatic vein embolization failed. Complications after LVD occurred in 14 patients (7%), including 7 hemorrhages/hematomas. After LVD, median FLR and standardized FLR ratios significantly increased to 46% (IQR 39-59, p<0.001) and 44% (IQR 35-50, p<0.001), corresponding to a median kinetic growth rate of 3.2%/week (IQR 1.6-5.3). Hepatectomy was performed in 142 patients (69 extended hepatectomies), while 49 dropped out (7 for insufficient hypertrophy (4%), 27 for tumor progression (14%), and 15 for other reasons (8%)). Seventy-one patients had postoperative complications (50%), and only 2 developed postoperative liver failure (1%). Median Comprehensive Complication Index was 20.9 (IQR 0-30.8) and 10 patients were reoperated (7%). Conclusion The preliminary data of this international registry showed that LVD had a high technical success rate (190/191) with few post-procedural complications and significant kinetic growth. Major hepatectomy after LVD appeared to be safe.

Acute cholecystitis is an inflammation of the gallbladder most often related to gallstones. The diagnostic and severity criteria are well described by the Tokyo criteria. Early laparoscopic cholecystectomy remains the treatment of choice. It can also be performed in elderly patients and in pregnant women during any trimester. For patients not eligible for surgery, percutaneous or echo-endoscopic gallbladder drainage (EUS-GBD) are effective treatment alternatives. The management of acute cholecystitis must therefore be adapted to each patient by carefully evaluating the risks and benefits associated with surgery.

Les patients atteints de cancer du pancréas présentent souvent une perte de poids et de masse musculaire. L'objectif de cette étude était d'évaluer le rôle de la sarcopénie sur les résultats postopératoires après pancréatectomie oncologique. Cette étude rétrospective inclut des patients opérés d'un cancer du pancréas entre 01/2015 et 12/2018. L'index musculaire squelettique (IMS ; quantité musculaire) a été mesuré au niveau de la troisième vertèbre lombaire (L3) sur des CT scans préopératoires. La sarcopénie a été définie sur la base de seuils préétablis, et son impact sur la morbidité postopératoire et la durée de séjour a été évalué. Les facteurs de risque indépendants pour des complications majeures (Clavien ≥ IIIa) ont été identifiés par analyse uni- et multivariée. Au total, 136 patients ont été inclus et 76 (56 %) étaient sarcopéniques. Ces patients étaient plus âgés (69 vs 64 ans, p = 0,004) et avaient un IMC plus faible (23 vs 26 kg/m2, p < 0,001). La durée médiane de séjour et le taux de complications majeures étaient comparables (16 vs 17 jours, p = 0,397, et 38 vs 40 %, p = 1,000). Les facteurs de risque indépendants de complications majeures identifiés étaient la fistule pancréatique (OR 6,811, < 0,001) et l'hémorragie postopératoire (OR 40,379, p < 0,001). L'augmentation de l'atténuation radiologique des muscles squelettiques (ARMS, qualité musculaire) était un facteur de protection (OR 0,909, p = 0,008). La sarcopénie préopératoire n'avait pas d'impact sur la morbidité et la durée de séjour après pancréatectomie oncologique. Cependant, la qualité musculaire était plus faible chez les patients avec complications majeures et semblait prévaloir sur la quantité musculaire.

Introduction: According to the Barcelona Clinic Liver Cancer (BCLC) staging system, liver resection (LR) is recommended for early-stage (BCLC-A) hepatocellular carcinoma (HCC) but is not a standard treatment for intermediate-stage (BCLC-B). The study aim was to assess surgical and oncological outcomes of LR in BCLC-A and B patients. Methods: This retrospective multicenter study included HCC patients with LR between January 2010 and December 2020 in four tertiary referral centers. Surgical outcomes of LR were assessed according to the Clavien classification. The overall survival (OS) and disease-free survival (DFS) were calculated by the Kaplan-Meier method. Results: Among 614 patients included, 564 were classified as BCLC-A and 50 as BCLC-B. Despite a higher clinically relevant complication (≥3b) rate in BCLC-B group (20.0 vs 8.0%, p=0.009), the incidence of overall complications (56.0 vs 41.5%, p=0.053) and mortality (0.0 vs 1.6%, p=1.000) did not differ between the two groups. Length of stay was significantly longer in BCLC-B group (12.9 vs 9.8 days, p<0.001). DFS was similar between BCLC-A and BCLC-B group (1-, 3-, and 5-year DFS: 66%, 24%, and 15% vs 67%, 35%, and 24%; p=0.766). OS was longer in BCLC-A group (1-, 3-, and 5-year OS of 93%, 70%, and 39% vs 83%, 48%, and 32%; p=0.015). Conclusions: LR for early and intermediate-stage HCC is safe providing careful preoperative selection. Despite better OS in BCLC-A patients, results of surgery in BCLC B patients were acceptable. These results will help to refine the BCLC staging system, which is probably too restrictive for surgery.

Purpose: Preoperative sarcopenia has been proposed as predictor for adverse outcomes. The aim of this study was to assess the role of preoperative sarcopenia on postoperative outcomes in patients undergoing liver resection. Methods: This retrospective mono-center study included consecutive patients undergoing liver resection between January 2014 and March 2020. Skeletal muscle index (SMI) was measured at the level of the third lumbar vertebra (L3) on preoperative computed tomographic (CT) scans. Preoperative sarcopenia was defined based on pre-established cut-offs, and its impact on postoperative morbidity and length of stay (LOS) was assessed. Major complications were defined as Clavien grade ≥ 3b. Results: A total of 355 patients were included and 212 (59.7%) were determined to have preoperative CT-based sarcopenia. Patients with sarcopenia were significantly older (63.5 years) and had lower BMI (23.9 kg/m2) than those without sarcopenia (59.3 years, p<0.01 and 27.7 kg/m2, p<0.01, respectively). There were significantly more men and ASA score ≥ 3 in the sarcopenic group (65.6 vs 49.9%, p<0.01, and 24.5 vs 7.0%, p<0.01, respectively). There was no difference in LOS and major complications rates between the 2 groups (8 vs 8 days, p=0.753 and 11.2 vs 11.3%, p=1.00, respectively). Conclusion: Sarcopenia had no impact on major complications and LOS in patients undergoing liver surgery. Therefore, its preoperative assessment may not provide clinically important information for all comers and should not be part of the standard preoperative workup.

Fungal infections are generally observed in immunosuppressed patients only, with a diagnostic challenge due to non-specific symptoms. For this reason, appropriate management may be delayed. This case report concerns a 36-year-old man with history of pancreas and kidney transplantation. He had chemotherapy for post-transplant B-cell lymphoma and presented with left upper abdominal pain and fever. Multiple investigations led to a final diagnosis of disseminated abdominal mucormycosis with multiple Rhizomucor abscesses in the liver, spleen and kidney transplant. Treatment was antifungal therapy and laparotomy with splenectomy, wedge resection of two fungal abscesses in segments II and IVb, and segmental left colic resection.

L’évaluation préopératoire de la réserve fonctionnelle hépatique est principalement destinée à réduire le risque d’insuffisance hépatique post-hépatectomie (PHLF). Cette étude a pour but d’évaluer la corrélation entre le test de rétention du vert d’indocyanine (test-ICG) et la pression portale selon l’étiologie de la cirrhose de même que l’incidence du PHLF dans chacun des groupes. Cinquante patients consécutifs, avec une tumeur maligne primitive du foie sur cirrhose hépatique, ont été inclus prospectivement entre 2009–2018. Une analyse de corrélation entre test-ICG et la pression portale selon l’étiologie de la cirrhose a été réalisée à l’aide du test de corrélation de rang de Spearman. Des analyses univariées et multivariées ont été effectuées pour évaluer des éventuels facteurs de prédiction du PHLF pour les cirrhoses alcooliques ou virales. Trente et un patients atteints de cirrhose alcoolique (groupe AC) et 19 patients atteints de cirrhose virale (groupe VC) ont bénéficié d’une résection hépatique. Il n’y a pas de différence significative du taux de rétention ICG à 15 min (ICG-R15), du gradient de pression veineuse hépatique (HVPG) de présence d’une d’hypertension portale, ou de morbidité postopératoire entre les groupes. Le coefficient de corrélation de rang de Spearman de ICG-R15 et HVPG est : r = 0,555 (p = 0,026) dans le groupe AC et r = 0,534 (p = 0,007) dans le groupe VC. La présence d’une hypertension portale (p = 0,034), d’un grade ALICE ≥ 2b avec hépatectomie majeure (p = 0,035) ou de pertes sanguines ≥ 500 mL (p = 0,005) sont associés de manière significative au PHLF. En analyses multivariées, les pertes sanguines ≥ 500 mL (p = 0,026) est le seul facteur de risque indépendant de développer une PHLF. L’étiologie de la cirrhose n’influence pas la corrélation entre la pression portale et test-ICG.

Purpose: Pelvic fractures are severe injuries with frequently associated multisystem trauma and a high mortality rate. We aimed to assess whether skeletal muscle mass and quality measured with computed tomography (CT) at admission in the emergency department predict mortality in patients with pelvic fractures.

Background The death of a patient is experienced at some time by most surgeons. The aim of this review was to use existing literature to establish how surgeons have dealt with the death of patients. Methods A systematic review of the medical literature was performed. MEDLINE/PubMed, Ovid, Web of Science, Embase, and Google Scholar were searched for qualitative and quantitative studies on surgeon reactions when facing death or a dying patient. This systematic review was performed following the recommendations of the Cochrane collaboration and reported following the PRISMA guidelines. Individual and interview-based opinions were summarized and synthesized. Results An initial search found 652 articles. After exclusion of articles that did not satisfy the inclusion criteria, 20 articles remained and seven were included. Two of these articles were personal opinion of the author and five were interviews or surveys. The main findings were that facing death routinely induces a strong psychological burden and that surgeons are more at risk than the general population to develop psychological morbidity. Conclusion Although it is a frequent and emotional subject in the surgical world, the impact of patient death on surgeons is not abundantly studied in the literature. Dealing with patient death or taking care of a dying patient might have long-lasting psychological impact on surgeons.

HaemophiliaVolume 20, Issue 2 p. e191-e192 Letter to the Editor A successful case of right hepatectomy in a patient with von Willebrand disease T. Kokudo, Corresponding Author T. Kokudo Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland Correspondence: Dr Takashi Kokudo, Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel.: +41213142871; fax: +41213142851; e-mail: [email protected]Search for more papers by this authorE. Uldry, E. Uldry Department of Visceral Surgery, Lausanne University Hospital, Lausanne, SwitzerlandSearch for more papers by this authorS. Degrauwe, S. Degrauwe Department of Internal Medicine, Lausanne University Hospital, Lausanne, SwitzerlandSearch for more papers by this authorN. Demartines, N. Demartines Department of Visceral Surgery, Lausanne University Hospital, Lausanne, SwitzerlandSearch for more papers by this authorN. Halkic, N. Halkic Department of Visceral Surgery, Lausanne University Hospital, Lausanne, SwitzerlandSearch for more papers by this author T. Kokudo, Corresponding Author T. Kokudo Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland Correspondence: Dr Takashi Kokudo, Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel.: +41213142871; fax: +41213142851; e-mail: [email protected]Search for more papers by this authorE. Uldry, E. Uldry Department of Visceral Surgery, Lausanne University Hospital, Lausanne, SwitzerlandSearch for more papers by this authorS. Degrauwe, S. Degrauwe Department of Internal Medicine, Lausanne University Hospital, Lausanne, SwitzerlandSearch for more papers by this authorN. Demartines, N. Demartines Department of Visceral Surgery, Lausanne University Hospital, Lausanne, SwitzerlandSearch for more papers by this authorN. Halkic, N. Halkic Department of Visceral Surgery, Lausanne University Hospital, Lausanne, SwitzerlandSearch for more papers by this author First published: 18 February 2014 https://doi.org/10.1111/hae.12378Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Rose E, Forster A, Aledort LM. Correction of prolonged bleeding time in von Willebrand's disease with Humate-P. Transfusion 1990; 30: 381. 10.1046/j.1537-2995.1990.30490273452.x CASPubMedWeb of Science®Google Scholar 2Mannucci PM. Treatment of von Willebrand's Disease. N Engl J Med 2004; 351: 683–94. 10.1056/NEJMra040403 CASPubMedWeb of Science®Google Scholar 3Gill JC, Shapiro A, Valentino LA et al. von Willebrand factor/factor VIII concentrate (Humate-P) for management of elective surgery in adults and children with von Willebrand disease. Haemophilia 2011; 17: 895–905. 10.1111/j.1365-2516.2011.02534.x CASPubMedWeb of Science®Google Scholar 4Imamura H, Seyama Y, Kokudo N et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003; 138: 1198–206. 10.1001/archsurg.138.11.1198 PubMedWeb of Science®Google Scholar 5Fan ST, Lo CM, Liu CL et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 1999; 229: 322–30. 10.1097/00000658-199903000-00004 CASPubMedWeb of Science®Google Scholar 6Tzeng CW, Katz MH, Fleming JB et al. Risk of venous thromboembolism outweighs post-hepatectomy bleeding complications: analysis of 5651 National Surgical Quality Improvement Program patients. HPB 2012; 14: 506–13. 10.1111/j.1477-2574.2012.00479.x PubMedWeb of Science®Google Scholar 7Gerling V, Lahpor JR, Buhre W. Peri-operative management of an adult patient with type 2N von Willebrand's disease scheduled for coronary artery bypass graft. Anaesthesia 2007; 62: 405–8. 10.1111/j.1365-2044.2007.05001.x CASPubMedWeb of Science®Google Scholar 8Goudemand J, Negrier C, Ounnoughene N, Sultan Y. Clinical management of patients with von Willebrand's disease with a VHP vWF concentrate: the French experience. Haemophilia 1998; 4: 48–52. 10.1046/j.1365-2516.1998.0040s3048.x PubMedWeb of Science®Google Scholar Citing Literature Volume20, Issue2March 2014Pages e191-e192 ReferencesRelatedInformation

Background: For patients with colorectal cancer and synchronous liver metastasis, the reverse approach inverts the classical treatment sequence as it starts with systemic chemotherapy, followed by resection of the liver metastases, and finally removal of the primary tumor. This current study aimed to assess the feasibility and long-term survival after a reverse treatment.