Citations 12
Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul‐de‐sac or the birth pangs of a new technical framework?
Iwashita, Yukio , Hibi, Taizo , Ohyama, Tetsuji , Umezawa, Akiko , Takada, Tadahiro , Strasberg, Steven M. , Asbun, Horacio J. , Pitt, Henry A. , Hwang, Tsann‐Long , Choi, In‐Seok , Yoon, Dong Sup , Huang, Wayne Shih‐Wei, Yoshida, Masahiro , Wakabayashi, Go , Miura, Fumihiko, Okamoto, Kohji , Endo, Itaru , Santibáñes, Eduardo de , Giménez, Mariano , Windsor, John A. , Garden, O. James , Gouma, Dirk J., Cherqui, Daniel , Belli, Giulio, Dervenis, Christos, Deziel, Daniel J., Jonas, Eduard , Jagannath, P., Supe, Avinash , Singh, Harjit , Liau, Kui‐Hin, Chan, Angus C. W., Lau, Wan Yee , Fan, Sheung Tat , Chen, Miin‐Fu , Kim, Myung‐Hwan , Sugioka, Atsushi , Asai, Koji , Wada, Keita, Mori, Yasuhisa , Higuchi, Ryota , Misawa, Takeyuki , Matsumura, Naoki , Rikiyama, Toshiki, Kano, Nobuyasu, Tokumura, Hiromi, Kimura, Taizo, Kitano, Seigo, Inomata, Masafumi , Sumiyama, Yoshinobu, Inui, Kazuo, Yamamoto, Masakazu , Han, Ho-Seong , Suzuki, Kenji S. , Yoon, Yoo-Seok , Chen, Xiao‐Ping , Honda, Goro , Watanabe, Manabu , Sata, Naohiro , Hirata, Koichi , Jonas, Eduard
Journal of Hepato-Biliary-Pancreatic Sciences | September 8, 2017 | Volume: 24 | Issue: 11 | Pages: 591-602
Abstract Bile duct injury ( BDI ) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons’ perceptions is scarce. Surgeons from Japan, Korea, Taiwan, and the USA, etc. ( n = 614) participated in a questionnaire regarding their BDI experience and near‐misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five‐point scale. The consensus was built when ≥80% of overall responses were 4 or 5. Response rates for the first‐ and second‐round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI . Final consensus was reached on: (1) Effective retraction of the gallbladder, (2) Always obtaining critical view of safety, and (3) Avoiding excessive use of electrocautery/clipping as vital procedures; and (4) Calot's triangle area and (5) Critical view of safety as important landmarks. For (6) Impacted gallstone and (7) Severe fibrosis/scarring in Calot's triangle, bail‐out procedures may be indicated. A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI .
Liver transplantation for “very early” intrahepatic cholangiocarcinoma: International retrospective study supporting a prospective assessment
Facciuto, Marcelo , Rubbia‐Brandt, Laura , Martí, Josep , Mehta, Neil , Yao, Francis Y. , Vibert, Éric , Cherqui, Daniel , Grant, David , Hernandez‐Alejandro, Roberto, Dale, Cheryl, Pinna, Antonio Daniele , Hwang, Shin , Lee, S.G., Busuttil, Ronald W. , Rizvi, Sumera, Montenovo, Martin I. , Reyes, Jorgé , Cesaretti, Manuela , Reichman, Trevor , Seal, John, Kim, P.T.W., Klintmalm, Göran B. , Sposito, Carlo , Mazzaferro, Vincenzo , Dutkowski, Philipp , Clavien, Pierre‐Alain , Toso, Christian , Majno, Pietro, Kneteman, Norman M. , Bruix, Jordi , Sapisochín, Gonzalo , Cucchetti, Alessandro , Agopian, Vatche G. , Heimbach, Julie K. , Soubrane, Olivier , Kim, P T W, Saunders, C., Mazzaferro, Vincenzo , Bruix, Jordi , Sposito, Carlo , Toso, Christian
Hepatology | August 3, 2016 | Volume: 64 | Issue: 4 | Pages: 1178-1188
The presence of an intrahepatic cholangiocarcinoma (iCCA) in a cirrhotic liver is a contraindication for liver transplantation in most centers worldwide. Recent investigations have shown that “very early” iCCA (single tumors ≤2 cm) may have acceptable results after liver transplantation. This study further evaluates this finding in a larger international multicenter cohort. The study group was composed of those patients who were transplanted for hepatocellular carcinoma or decompensated cirrhosis and found to have an iCCA at explant pathology. Patients were divided into those with “very early” iCCA and those with “advanced” disease (single tumor >2 cm or multifocal disease). Between January 2000 and December 2013, 81 patients were found to have an iCCA at explant; 33 had separate nodules of iCCA and hepatocellular carcinoma, and 48 had only iCCA (study group). Within the study group, 15/48 (31%) constituted the “very early” iCCA group and 33/48 (69%) the “advanced” group. There were no significant differences between groups in preoperative characteristics. At explant, the median size of the largest tumor was larger in the “advanced” group (3.1 [2.5‐4.4] versus 1.6 [1.5‐1.8]). After a median follow‐up of 35 (13.5‐76.4) months, the 1‐year, 3‐year, and 5‐year cumulative risks of recurrence were, respectively, 7%, 18%, and 18% in the very early iCCA group versus 30%, 47%, and 61% in the advanced iCCA group, P = 0.01. The 1‐year, 3‐year, and 5‐year actuarial survival rates were, respectively, 93%, 84%, and 65% in the very early iCCA group versus 79%, 50%, and 45% in the advanced iCCA group, P = 0.02. Conclusion: Patients with cirrhosis and very early iCCA may become candidates for liver transplantation; a prospective multicenter clinical trial is needed to further confirm these results. (H epatology 2016;64:1178‐1188)