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Abraham Lebenthal - One of the best experts on this subject based on the ideXlab platform.
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oncological outcomes of lobar Resection segmentectomy and wedge Resection for t1a non small cell lung carcinoma a systematic review and meta analysis
Seminars in Thoracic and Cardiovascular Surgery, 2020Co-Authors: Michiel A Ijsseldijk, Melina Shoni, Charles Siegert, Jan Seegers, Anton K C Van Engelenburg, Thomas C Tsai, Abraham LebenthalAbstract:The optimal treatment of early-stage non–small-cell lung cancer (NSCLC) remains subject to debate. Lobar Resection is considered the standard of care, but sublobar Resections are a lung parenchymal-sparing treatment offering promising results. We conducted a systematic review and meta-analysis to compare oncological outcomes of lobar Resections and parenchymal-sparing Resections for T1a NSCLC. PubMed, EMBASE, Web of Knowledge Search, and the Cochrane Central Register of Controlled Trials were searched for studies reporting oncological outcomes following lobar or parenchymal-sparing Resections. Two researchers independently identified studies and extracted data. Oncological outcomes were compared for each surgical modality using the Mantel-Haenszel method, and outcomes were pooled for each modality using the inverse variance method. A total of 11,195 studies were identified and 28 articles were included. For pT1a tumors, there was no difference in 5-year overall survival when lobar Resection (n = 15,003) was compared to parenchymal-sparing Resection (n = 1224), with a relative risk of 0.92 (95% confidence interval: 0.84–1.01). Five-year overall survival and disease-free survival after segmentectomy yielded equal survival compared to lobar Resection in directly comparing studies and point estimates of noncomparative studies. In most comparisons, wedge Resection showed comparable results to lobar Resections and segmentectomy. Subanalysis of intentional parenchymal-sparing surgery showed favorable results. This study shows that parenchymal-sparing surgery yields equivocal survival compared to lobar surgery for stage T1a NSCLC. However, a drawback in implementing parenchymal-sparing Resection for lobectomy-tolerable patients is the risk of nodal upstaging.
Steven M Strasberg - One of the best experts on this subject based on the ideXlab platform.
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completion of a liver surgery complexity score and classification based on an international survey of experts
Journal of The American College of Surgeons, 2016Co-Authors: Major K Lee, Steven M Strasberg, Feng GaoAbstract:Background Liver Resections have classically been distinguished as "minor" or "major," based on number of segments removed. This is flawed because the number of segments resected alone does not convey the complexity of a Resection. We recently developed a 3-tiered classification for the complexity of liver Resections based on utility weighting by experts. This study aims to complete the earlier classification and to illustrate its application. Study Design Two surveys were administered to expert liver surgeons. Experts were asked to rate the difficulty of various open liver Resections on a scale of 1 to 10. Statistical methods were then used to develop a complexity score for each procedure. Results Sixty-six of 135 (48.9%) surgeons responded to the earlier survey, and 66 of 122 (54.1%) responded to the current survey. In all, 19 procedures were rated. The lowest mean score of 1.36 (indicating least difficult) was given to peripheral wedge Resection. Right hepatectomy with IVC reconstruction was deemed most difficult, with a score of 9.35. Complexity scores were similar for 9 procedures present in both surveys. Caudate Resection, hepaticojejunostomy, and vascular reconstruction all increased the complexity of standard Resections significantly. Conclusions These data permit quantitative assessment of the difficulty of a variety of liver Resections. The complexity scores generated allow for separation of liver Resections into 3 categories of complexity (low complexity, medium complexity, and high complexity) on a quantitative basis. This provides a more accurate representation of the complexity of procedures in comparative studies.
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perceived complexity of various liver Resections results of a survey of experts with development of a complexity score and classification
Journal of The American College of Surgeons, 2015Co-Authors: Steven M StrasbergAbstract:Background Liver Resections have classically been distinguished as "minor" or "major" based on the number of segments removed. However, it is clear that the number of segments alone does not convey the complexity of a Resection. To date, no study has formally assessed the complexity of various anatomic liver Resections. Study Design A 4-question survey was administered to 135 expert liver surgeons in 14 countries. The first 3 questions related to the country in which the surgeon was practicing and the surgeon's experience. In the fourth question, the experts were asked to rate the difficulty of various open, anatomic liver Resections on a scale of 1 to 10. Results Sixty-six of 135 (48.9%) surgeons responded to the survey. Twelve procedures were rated. The lowest mean score of 1.37—indicating least difficulty—was given to peripheral wedge Resection. Left trisectionectomy with caudate Resection was deemed most difficult, with a score of 8.28. The mean scores for the 2 procedures perceived as least difficult—peripheral wedge Resection and left lateral sectionectomy—were lower than the mean scores of all the rest of the procedures at a highly statistically significant level (p Conclusions These data represent the first quantitative assessment of the perceived difficulty of a variety of liver Resections. The complexity scores generated allow for separation of liver Resections into 3 categories of complexity (low complexity, medium complexity, and high complexity) on a quantitative basis.
David A. Geller - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic liver Resection--current update.
Surgical Clinics of North America, 2010Co-Authors: Kevin Tri Nguyen, David A. GellerAbstract:Laparoscopic hepatic Resection is an emerging option in the field of hepatic surgery. With almost 3000 laparoscopic hepatic Resections reported in the literature for benign and malignant tumors, with a combined mortality of 0.3% and morbidity of 10.5%, there will be an increasing demand for minimally invasive liver surgery. 1 Multiple series have been published on laparoscopic liver Resections; however, no randomized controlled trial has been reported that compares laparoscopic with open liver Resection. Large series, meta-analyses, and reviews have thus far attested to the feasibility and safety of minimally invasive hepatic surgery for benign and malignant lesions. 2–17 The largest single-center experience was published by Koffron and colleagues 3 and describes various minimally invasive approaches to liver Resection, including pure laparoscopic, hand-assisted laparoscopic, and laparoscopic-assisted open (hybrid) techniques. The choice of the minimally invasive approach should depend on surgeon experience, tumor size, location, and the extent of liver Resection. This article reviews the literature on reports comparing laparoscopic with hepatic Resections. Special emphasis is on the cumulative world literature on laparoscopic liver surgery, the consensus meeting on laparoscopic liver Resection, the learning curve on laparoscopic liver Resection, laparoscopic major hepatectomies, shortterm benefits after laparoscopic liver Resection, and survival outcomes for laparoscopic liver Resection of hepatocellular carcinoma (HCC) and colorectal liver metastasis. Finally, financial cost comparisons are evaluated to determine the cost advantages or disadvantages of the laparoscopic approach. WORLD REVIEW SincethefirstlaparoscopicliverResectionwasreportedin1992,therehasbeenanexponential increase in the number of reported laparoscopic liver Resection, with more than 127 published articles, totaling almost 3000 reported cases of laparoscopic liver Resection. 1 Half of the reported cases were performed for malignant lesions and 45% for
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world review of laparoscopic liver Resection 2 804 patients
Annals of Surgery, 2009Co-Authors: Kevin Tri Nguyen, T C Gamblin, David A. GellerAbstract:Objective: To provide a review of the world literature on laparoscopic liver Resection. Summary Background Data: Initially described for peripheral, benign tumors resected by nonanatomic wedge Resections, minimally invasive liver Resections are now being performed more frequently, even for larger, malignant tumors located in challenging locations. Although a few small review articles have been reported, a comprehensive review on laparoscopic liver Resection has not been published. Methods: We conducted a literature search using Pubmed, screening all English publications on laparoscopic liver Resections. All data were analyzed and apparent case duplications in updated series were excluded from the total number of patients. Tumor type, operative characteristics, perioperative morbidity, and oncologic outcomes were tabulated. Results: A total of 127 published articles of original series on laparoscopic liver Resection were identified, and accounted for 2,804 reported minimally invasive liver Resections. Fifty percent were for malignant tumors, 45% were for benign lesions, 1.7% were for live donor hepatectomies, and the rest were indeterminate. Of the Resections, 75% were performed totally laparoscopically, 17% were hand-assisted, and 2% were laparoscopic-assisted open hepatic Resection (hybrid) technique, with the remainder being other techniques or conversions to open hepatectomies. The most common laparoscopic liver Resection was a wedge Resection or segmentectomy (45%) followed by anatomic left lateral sectionectomy (20%), right hepatectomy (9%), and left hepatectomy (7%). Conversion from laparoscopy to open laparotomy and from laparoscopy to hand-assisted approach occurred in 4.1% and 0.7% of reported cases, respectively. Overall mortality was 9 of 2,804 patients (0.3%), and morbidity was 10.5%, with no intraoperative deaths reported. The most common cause of postoperative death was liver failure. Postoperative bile leak was observed in 1.5% of cases. For cancer Resections, negative surgical margins were achieved in 82% to 100% of reported series. The 5-year overall and disease-free survival rates after laparoscopic liver Resection for hepatocellular carcinoma were 50% to 75% and 31% to 38.2%, respectively. The 3-year overall and disease-free survival rates after laparoscopic liver Resection for colorectal metastasis to the liver were 80% to 87% and 51%, respectively. Conclusion: In experienced hands, laparoscopic liver Resections are safe with acceptable morbidity and mortality for both minor and major hepatic Resections. Oncologically, 3- and 5-year survival rates reported for hepatocellular carcinoma and colorectal cancer metastases are comparable to open hepatic Resection, albeit in a selected group of patients.
Igor Mosin - One of the best experts on this subject based on the ideXlab platform.
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surgical treatment of larynx and tracheal cicatricial stenosis
European Respiratory Journal, 2013Co-Authors: Igor Mosin, Nina Mosina, Olga Lukina, Alexander PrudnikovAbstract:The main aim of the study was to show the effect of one-stage Resection of the larynx below the glottis and the upper third of the trachea with formation of primary anastomosis and without setting of a stent in the region of scarring .Resections of larynx and tracheal regions were performed in 35 patients On the basis of radiographic and bronchoscopic data distance from cicatricial lesion to the vocal folds 0.3 - 1 cm was found in 20 patients, 1 to 2 cm in 11, and from 2 to 2.5 cm in 4 cases. The average distance was 1.3 cm+0,7sm. Resections were performed by two techniques depending on the form of cicatricial stenosis of the distal part of the larynx with cutting out, or without cutting out flaps of the membranous wall of the trachea. In the circular form of cicatricial stenosis (18 patients) was performed a standard Pearson - Grillo Resection. In A-shaped or irregular scarring of distal part of larynx (17 patients) we performed a modified Pearson - Grillo resecteion. Results. Immediate and long-term results of Resections were assessed as good in 34 (97,1%) of 35 patients. Cicatricial stenosis of the anastomosis after surgery occurred in one patient and was eliminated by repeated bougie - procedure during bronchoscopy. Conclusions. Thus, one-stage Resections allowed us to perform the operation at any level from the vocal folds, with preservation of the stabilizing function of the larynx, without damage to the recurrent laryngeal nerve.
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Surgical treatment of primary malignancies of trachea
European Respiratory Journal, 2011Co-Authors: Igor Mosin, Nina Mosina, Olga Lukina, Yana DorofeevaAbstract:The main treatment of patients with primary malignant tumors of the trachea is endoscopic recanalization of the trachea lumen with stenting and radiotherapy. Radical surgery of the trachea primary malignancies is single-step circular Resection with end-to-end anastomosis. The aim was to demonstrate that a single-step circular Resection is possible when tumor extension is 45% of the trachea length, with involvement of the epiglottis subfold portion. 18 single-step circular Resections were performed in patients with primary tumor of the trachea. Adenocystic cancer of the trachea was diagnosed in 13 subjects, and typical carcinoid – in 5. Among them over 45% of trachea was resected in 10 patients. Localisation and extension of the tumor was established by fibrobronchoscopy, and MDCT. Tumor extension from 1.0 to 3.0sm was diagnosed in 8 patients, and from 3.0 to 6.0sm – in 10 patients. Single-step circular Resections and tracheotracheal anastomosis were performed in 7 patients, laryngotracheal anastomosis - in 6, and a laryngotracheal Resections were made in 5 patients. Immediate and prospective results of the treatment are considered to be sufficient in all patients. In Pearson-Grillo laryngotracheal Resection the distance between the anastomosis and vocal cords varied from 1 sm to 3 sm. Single-step circular Resection is the only radical surgical treatment of primary trachea malignancies. Subfold portion involvement is not a contraindication to a single-step circular Resection of the trachea and subfolder portion of the epiglottis. Postoperatively, a single-step circular Resection for adenocystic cancer must be followed by radiotherapy.
Clancy J Clark - One of the best experts on this subject based on the ideXlab platform.
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bile duct surgery in the treatment of hepatobiliary and gallbladder malignancies effects of hepatic and vascular Resection on outcomes
Hpb, 2015Co-Authors: Perry Shen, Nora F Fino, Edward A Levine, Pamela Eversole, Clancy J ClarkAbstract:Background Resection of the bile duct is required for the treatment of cholangiocarcinoma and is sometimes indicated in Resections of liver and gallbladder malignancies. The goal of this retrospective review was to characterize surgical outcomes in patients submitted to bile duct Resection for malignancy when additional procedures, specifically hepatic or vascular Resections, were performed.
