Publications
334 results found
Reccia I, Kumar J, Kusano T, et al., 2018, Radiofrequency-assisted liver resection: Technique and results, Surgical Oncology, Vol: 27, Pages: 415-420, ISSN: 0960-7404
BackgroundRadiofrequency (RF)-assisted liver resection allows non-anatomical liver resection with reduced blood loss and offers the opportunity for a combination of resection and ablation. However, there are still concerns with regard to postoperative complications related to this technique. In the present study, we discuss the technical aspects of RF-assisted liver resections and analyse the rate of perioperative complications, focusing on post-hepatectomy liver failure (PLF), bile leak and abscess, and mortality.MethodsBetween 2001 and 2015, 857 consecutive open and laparoscopic elective RF-assisted liver resections for benign and malignant liver tumours were reviewed retrospectively to assess perioperative outcomes.ResultsMedian intraoperative blood loss was 130 mL, with 9.8% of patients requiring blood transfusion. Intra-abdominal collections requiring percutaneous drainage developed in 8.7% of all patients, while bile leak at resection margin developed in 2.8% of the cases. Major liver resection was performed in 34% of patients and the incidence of PLF was 1.5% with one directly related mortality (0.1%).ConclusionRF-assisted liver resection has evolved into a feasible and safe technique of liver resection with an acceptable incidence of perioperative morbidity and a low incidence of PLF and related mortality.
Nasser S, Lathouras K, Nixon K, et al., 2018, IMPACT OF RIGHT UPPER QUADRANT CYTOREDUCTIVE TECHNIQUES WITH EXTENSIVE LIVER MOBILISATION ON POSTOPERATIVE HEPATIC FUNCTION IN PATIENTS WITH ADVANCED OVARIAN CANCER, Publisher: BMJ PUBLISHING GROUP, Pages: 681-681, ISSN: 1048-891X
Reccia I, Sodergren MH, Jayant K, et al., 2018, The journey of radiofrequency-assisted liver resection, Surgical Oncology, Vol: 27, Pages: A16-A18, ISSN: 0960-7404
Ottaviani S, Stebbing J, Frampton AE, et al., 2018, TGF-beta induces miR-100 and miR-125b but blocks let-7a through LIN28B controlling PDAC progression, Nature Communications, Vol: 9, ISSN: 2041-1723
TGF-β/Activin induces epithelial-to-mesenchymal transition and stemness in pancreatic ductal adenocarcinoma (PDAC). However, the microRNAs (miRNAs) regulated during this response have remained yet undetermined. Here, we show that TGF-β transcriptionally induces MIR100HG lncRNA, containing miR-100, miR-125b and let-7a in its intron, via SMAD2/3. Interestingly, we find that although the pro-tumourigenic miR-100 and miR-125b accordingly increase, the amount of anti-tumourigenic let-7a is unchanged, as TGF-β also induces LIN28B inhibiting its maturation. Notably, we demonstrate that inactivation of miR-125b or miR-100 affects the TGF-β-mediated response indicating that these miRNAs are important TGF-β effectors. We integrate AGO2-RIP-seq with RNA-seq to identify the global regulation exerted by these miRNAs in PDAC cells. Transcripts targeted by miR-125b and miR-100 significantly overlap and mainly inhibit p53 and cell–cell junctions’ pathways. Together, we uncover that TGF-β induces an lncRNA, whose encoded miRNAs, miR-100, let-7a and miR-125b play opposing roles in controlling PDAC tumourigenesis.
Frampton AE, Mato Prado M, Lopez Jimenez ME, et al., 2018, Glypican-1 is enriched in circulating-exosomes in pancreatic cancer and correlates with tumor burden, Oncotarget, Vol: 9, Pages: 19006-19013, ISSN: 1949-2553
Background: Glypican-1 (GPC1) is expressed in pancreatic ductal adenocarcinoma (PDAC) cells and adjacent stroma fibroblasts. Recently, GPC1 circulating exosomes (crExos) have been shown to be able to detect early stages of PDAC. This study investigated the usefulness of crExos GPC1 as a biomarker for PDAC.Methods: Plasma was obtained from patients with benign pancreatic disease (n = 16) and PDAC (n = 27) prior to pancreatectomy, and crExos were isolated by ultra-centrifugation. Protein was extracted from surgical specimens (adjacent normal pancreas, n = 13; and PDAC, n = 17). GPC1 levels were measured using enzyme-linked immunosorbent assay (ELISA). Results: There was no significant difference in GPC1 levels between normal pancreas and PDAC tissues. This was also true when comparing matched pairs. However, GPC1 levels were enriched in PDAC crExos (n = 11), compared to the source tumors (n = 11; 97 ± 54 vs. 20.9 ± 12.3 pg/mL; P < 0.001). In addition, PDACs with high GPC1 expression tended to have crExos with high GPC1 levels. Despite these findings, we were unable to distinguish PDAC from benign pancreatic disease using crExos GPC1 levels. Interestingly, we found that in matched pre and post-operative plasma samples there was a significant drop in crExos GPC1 levels after surgical resection for PDAC (n = 11 vs. 11; 97 ± 54 vs. 77.8 ± 32.4 pg/mL; P = 0.0428). Furthermore, we found that patients with high crExos GPC1 levels have significantly larger PDACs (>4 cm; P = 0.012). Conclusions: High GPC1 crExos may be able to determine PDAC tumor size and disease burden. However, further efforts are needed to elucidate its role as a diagnostic and/or prognostic biomarker using larger cohorts of PDAC patients.
Garas G, Markar SR, Malietzis G, et al., 2017, Induced Bias Due to Crossover Within Randomized Controlled Trials in Surgical Oncology: A Meta-regression Analysis of Minimally Invasive versus Open Surgery for the Treatment of Gastrointestinal Cancer., Annals of Surgical Oncology, Vol: 25, Pages: 221-230, ISSN: 1068-9265
BACKGROUND: Randomized controlled trials (RCTs) inform clinical practice and have provided the evidence base for introducing minimally invasive surgery (MIS) in surgical oncology. Crossover (unplanned intraoperative conversion of MIS to open surgery) may affect clinical outcomes and the effect size generated from RCTs with homogenization of randomized groups. OBJECTIVES: Our aims were to identify modifiable factors associated with crossover and assess the impact of crossover on clinical endpoints. METHODS: A systematic review was performed to identify all RCTs comparing MIS with open surgery for gastrointestinal cancer (1990-2017). Meta-regression analysis was performed to analyze factors associated with crossover and the influence of crossover on endpoints, including 30-day mortality, anastomotic leak rate, and early complications. RESULTS: Forty RCTs were included, reporting on 11,625 patients from 320 centers. Crossover was shown to affect one in eight patients (mean 12.6%, range 0-45%) and increased with American Society of Anesthesiologists score (β = + 0.895; p = 0.050). Pretrial surgeon volume (β = - 2.344; p = 0.037), composite RCT quality score (β = - 7.594; p = 0.014), and site of tumor (β = - 12.031; p = 0.021, favoring lower over upper gastrointestinal tumors) showed an inverse relationship with crossover. Importantly, multivariate weighted linear regression revealed a statistically significant positive correlation between crossover and 30-day mortality (β = + 0.125; p = 0.033), anastomotic leak rate (β = + 0.550; p = 0.004), and early complications (β = + 1.255; p = 0.001), based on intention-to-treat analysis. CONCLUSIONS: Crossover in trials was associated with an increase in 30-day mortality, anastomotic leak rate, and early complications within the MIS group based on intention-
Nasser S, Lathouras K, Campbell J, et al., 2017, IMPACT OF RIGHT UPPER QUADRANT CYTOREDUCTIVE TECHNIQUES FOR ADVANCED OVARIAN CANCER ON POSTOPERATIVE HEPATIC FUNCTION AND LIVER FAILURE, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 514-514, ISSN: 1048-891X
Jawad ZAR, Theodorou I, Jiao LR, et al., 2017, Highly Sensitive Plasmonic Detection of the Pancreatic Cancer Biomarker CA 19-9, Scientific Reports, Vol: 7, ISSN: 2045-2322
Plasmonic gold (Au) nanotriangular arrays, functionalized with a near infrared (NIR) fuorophoreconjugatedimmunoassay to Carbohydrate Antigen 19-9 (CA 19-9), a pancreatic cancer biomarker,produce optically tunable substrates with two orders of magnitude fuorescence enhancement.Through nanoscale morphological control, the sensitivities of the plasmonic nanotriangular arraysare controllable, paving the way of such optical platforms for multiplexing. Here, we report a limit ofdetection (LOD) of 7.7×10−7 U.mL−1 for CA 19–9 by using such tunable Au nanotriangular arrays, agreat improvement compared to commercially available CA 19–9 immunoassays. The linear dynamicrange was from 1×10−6 U.mL−1 to 1 U.mL−1, i.e. up to six orders of magnitude. Moreover, highspecifcity was demonstrated, together with successful validation in serum samples. Their superiortunable sensitivity, along with eforts to combine CA 19–9 with other biomarkers for improved accuracy,open up the possibility for multiplexed NIR-fuorescence enhancement microarrays, for early cancerdiagnosis and therapeutic monitoring.
Poo S, Pencavel TD, Jackson J, et al., 2017, Portal hypertension and chylous ascites complicating acute pancreatitis: the therapeutic value of portal vein stenting., Annals of The Royal College of Surgeons of England, Pages: e1-e3, ISSN: 0035-8843
Chylous ascites as a consequence of acute pancreatitis is very rare. We present an unusual case of a 73-year-old man who developed refractory chylous ascites one month after an acute severe episode of gallstone pancreatitis, associated with portal hypertension. He was successfully treated with portal vein stenting, which has remained patent to date.
Pugh S, Bridgewater J, Finch-Jones M, et al., 2017, Surgical quality and the impact of liver resection on outcome in the new EPOC study, 42nd European-Society-for-Medical-Oncology Congress (ESMO), Publisher: OXFORD UNIV PRESS, ISSN: 0923-7534
Erridge S, Pucher PH, Markar SR, et al., 2017, Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma, British Journal of Surgery, Vol: 104, Pages: 1433-1442, ISSN: 1365-2168
BackgroundIntrahepatic recurrence of hepatocellular carcinoma (HCC) following resection is common. However, no current consensus guidelines exist to inform management decisions in these patients. Systematic review and meta-analysis of survival following different treatment modalities may allow improved treatment selection. This review aimed to identify the optimum treatment strategies for HCC recurrence.MethodsA systematic review, up to September 2016, was conducted in accordance with MOOSE guidelines. The primary outcome was the hazard ratio for overall survival of different treatment modalities. Meta-analysis of different treatment modalities was carried out using a random-effects model, with further assessment of additional prognostic factors for survival.ResultsNineteen cohort studies (2764 patients) were included in final data analysis. The median 5-year survival rates after repeat hepatectomy (525 patients), ablation (658) and transarterial chemoembolization (TACE) (855) were 35·2, 48·3 and 15·5 per cent respectively. Pooled analysis of ten studies demonstrated no significant difference between overall survival after ablation versus repeat hepatectomy (hazard ratio 1·03, 95 per cent c.i. 0·68 to 1·55; P = 0·897). Pooled analysis of seven studies comparing TACE with repeat hepatectomy showed no statistically significant difference in survival (hazard ratio 1·61, 0·99 to 2·63; P = 0·056).ConclusionBased on these limited data, there does not appear to be a significant difference in survival between patients undergoing repeat hepatectomy or ablation for recurrent HCC. The results also identify important negative prognostic factors (short disease-free interval, multiple hepatic metastases and large hepatic metastases), which may influence choice of treatment.
Frampton AE, Funel N, Giovannetti E, et al., 2017, y Dicing and slicing pancreatic cancer, 20th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: WILEY, Pages: 13-13, ISSN: 0007-1323
Khoo B, Boshier PR, Freethy A, et al., 2017, Redefining the stress cortisol response to surgery., Clinical Endocrinology, Vol: 87, Pages: 451-458, ISSN: 1365-2265
BACKGROUND: Cortisol levels rise with the physiological stress of surgery. Previous studies have used older, less-specific assays, have not differentiated by severity or only studied procedures of a defined type. The aim of this study was to examine this phenomenon in surgeries of varying severity using a widely used cortisol immunoassay. METHODS: Euadrenal patients undergoing elective surgery were enrolled prospectively. Serum samples were taken at 8 am on surgical day, induction and 1 hour, 2 hour, 4 hour and 8 hour after. Subsequent samples were taken daily at 8 am until postoperative day 5 or hospital discharge. Total cortisol was measured using an Abbott Architect immunoassay, and cortisol-binding globulin (CBG) using a radioimmunoassay. Surgical severity was classified by POSSUM operative severity score. RESULTS: Ninety-three patients underwent surgery: Major/Major+ (n = 37), Moderate (n = 33) and Minor (n = 23). Peak cortisol positively correlated to severity: Major/Major+ median 680 [range 375-1452], Moderate 581 [270-1009] and Minor 574 [272-1066] nmol/L (Kruskal-Wallis test, P = .0031). CBG fell by 23%; the magnitude of the drop positively correlated to severity. CONCLUSIONS: The range in baseline and peak cortisol response to surgery is wide, and peak cortisol levels are lower than previously appreciated. Improvements in surgery, anaesthetic techniques and cortisol assays might explain our observed lower peak cortisols. The criteria for the dynamic testing of cortisol response may need to be reduced to take account of these factors. Our data also support a lower-dose, stratified approach to dosing of steroid replacement in hypoadrenal patients, to minimize the deleterious effects of over-replacement.
Fuks D, Aldrighetti L, Jiao LR, et al., 2017, Laparoscopic Management of Hepatocellular Carcinoma: A Critical Reappraisal., Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, Vol: 27, Pages: 203-205, ISSN: 1530-4515
Following the introduction of the first laparoscopic liver resection, after ∼25 years, a critical reappraisal seems to be warranted. Liver resection represents the first choice for curing early hepatocellular carcinoma (HCC) allowing a curative chance also in selected patients with intermediate stage tumors. The criteria for liver resectability by laparoscopy remains the same for open surgery, which is oncological criteria (absence of extrahepatic tumor location; completely resectable R0 resection), anatomic (resectability of involved segment with its own blood surely and biliary drainage; absence of vascular invasion of portal or hepatic veins) and technical (possibility to leave in place a residual volume ≥40%). Anatomic resections being more challenging than wedged resections, were initially performed mainly for lesions located in the left liver (segments 2, 3, and 4) and segments 5 and 6 of the right liver (anterior and lateral hepatic segments). Left lateral segmentectomy seemed most suited for laparoscopic resection because of the thinness of the liver, the possibility of resection without hilar dissection, ease of stapling the left hepatic vein and portal pedicles of segment II and III by mechanical stapling. Conversely, right hepatectomy seemed most difficult and technically challenging to perform. The analysis of literature confirms that minor liver resections for HCC can be safely conducted also in cirrhotic patients and that laparoscopy, when feasible, should be the approach of first choice. As mentioned, there have been several studies that compared the long-term outcomes of laparoscopic hepatectomy (LH) versus open hepatectomy for HCC, even in cirrhotic patients, showing that laparoscopy does not seem to have any impact on the risk of postoperative HCC recurrence. However, further studies seem to be required, especially for long-term oncological results and for major hepatectomy, before LH become a common alternative to open liver surgery. The pr
Kent L, Aydin A, Ahmed K, et al., 2017, A systematic review and meta-analysis of robotic versus laparoscopic partial liver resection, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: Wiley, Pages: 186-186, ISSN: 1365-2168
Frampton AE, Ottaviani S, Stebbing J, et al., 2017, TGF-Beta Induces miR-100 and miR-125b Promoting EMT and Stemness in Pancreatic Cancer, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 6-6, ISSN: 0007-1323
Mallappa S, Poo S, Pencavel T, et al., 2017, Pancreatic incidentalomas on CT colonography: ignore, follow up or investigate?, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 54-54, ISSN: 0007-1323
Frampton AE, Ottaviani S, Stebbing J, et al., 2017, TGF-Beta Induces miR-100 and miR-125b Promoting EMT and Stemness in Pancreatic Cancer, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 21-21, ISSN: 0007-1323
Jawad ZAR, Fajardo-Puerta AB, Lefroy D, et al., 2017, Complete laparoscopic excision of a giant retroperitoneal paraganglioma, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 99, Pages: E148-E150, ISSN: 0035-8843
Erridge S, Markar S, Malietzis G, et al., 2017, The role of hepatic resection in breast cancer liver metastases and identification of prognostic factors for survival: a systematic review and meta-analysis, AHPBA 2017
Erridge S, Pucher P, Markar S, et al., 2017, Determinants Of Outcome And Survival Following Treatment Of Recurrent Hepatocellular Carcinoma: A Systematic Review & Meta-Analysis, AHPBA 2017
Erridge S, Sodergren MH, Jiao LR, 2016, Re: Gavriilidis et al., 'Survival following redo hepatectomy vs radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and meta-analysis', HPB, Vol: 19, Pages: 378-378, ISSN: 1365-182X
Yoon S, Huang K-W, Reebye V, et al., 2016, Targeted Delivery of C/EBPα -saRNA by Pancreatic Ductal Adenocarcinoma-specific RNA Aptamers Inhibits Tumor Growth <i>In Vivo</i> (vol 24, pg 1106, 2016), MOLECULAR THERAPY, Vol: 24, Pages: 2131-2132, ISSN: 1525-0016
Velasquez T, Mackey G, Lusk J, et al., 2016, ESICM LIVES 2016: part three : Milan, Italy. 1-5 October 2016., Intensive Care Med Exp, Vol: 4, Pages: 28-28
Jiao LR, 2016, Percutaneous Microwave Ablation Liver Partition and Portal Vein Embolization for Rapid Liver Regeneration: A Minimally Invasive First Step of ALPPS for Hepatocellular Carcinoma, Annals of Surgery, Vol: 264, Pages: E3-E3, ISSN: 1528-1140
Jiao LR, Hakim DN, Gall TMH, et al., 2016, A totally laparoscopic associating liver partition and portal vein ligation for staged hepatectomy assisted with radiofrequency (radiofrequency assisted liver partition with portal vein ligation) for staged liver resection, Hepatobiliary Surgery and Nutrition, Vol: 5, Pages: 382-387, ISSN: 2304-3881
In order to induce liver hypertrophy to enable liver resection in patients with a small future liver remnant, various methods have been proposed in addition to portal vein embolisation. Most recently, the ALPPS technique has gained significant international interest. This technique is limited by the high morbidity associated with an in-situ liver splitting and the patient undergoing two open operations. We present the case of a variant ALPPS technique performed entirely laparoscopically with no major morbidity or mortality. An increased liver volume of 57.9% was seen after 14 days. This technique is feasible to perform and compares favourably to other ALPPS methods whilst gaining the advantages of laparoscopic surgery.
Jiao LR, Gall TM, Sodergren MH, et al., 2016, Laparoscopic long sleeve pancreaticogastrostomy (LPG): a novel pancreatic anastomosis following central pancreatectomy, Hepatobiliary Surgery and Nutrition, Vol: 5, Pages: 245-248, ISSN: 2304-389X
BACKGROUND: Central pancreatectomy (CP) is preferred to distal pancreatectomy (DP) for the excision of benign tumours at the neck or body of the pancreas, in order to preserve pancreatic function and the spleen. However, the pancreaticoenterostomy is technically difficult to perform laparoscopically and the postoperative pancreatic fistula (POPF) rate is high. METHODS: A novel laparoscopic reconstruction of the pancreatic stump during CP is described, the laparoscopic long sleeve pancreaticogastrostomy (LPG). RESULTS: Two males and two females with a median age of 49 years had a laparoscopic CP with LPG. After a median follow-up of 27.5 months, there was no mortality. One patient had a grade A POPF, managed conservatively. CONCLUSIONS: The LPG is a safe and technically less demanding method to reconstruct pancreatic drainage laparoscopically.
Merrick B, Yue D, Sodergren MH, et al., 2016, Portobiliary fistula following laparoscopiccholecystectomy, Annals of the Royal College of Surgeons of England, Vol: 98, Pages: e123-e125, ISSN: 1478-7083
The laparoscopic approach has replaced open surgery as the gold standard for cholecystectomy. This technique is, however,associated with a greater incidence of bile duct injuries (BDIs). We report a case of portobiliary fistula (PBF), a rare complicationof BDI, occurring post laparoscopic cholecystectomy (LC). PBF has been reported after procedures such as endoscopicretrograde cholangiopancreatography and pathologies such as liver abscesses, but only once previously in the setting of LC. Wediscuss the management of this patient with apparent dual pathology, and summarise other aetiologies that may give rise tothis condition.
Giglio MC, Giakoustidis A, Draz A, et al., 2016, Oncological outcomes of major liver resection following portal vein embolization: a systematic review and a meta-analysis, Annals of Surgical Oncology, Vol: 23, Pages: 3709-3717, ISSN: 1534-4681
Background Preoperative portal vein occlusion with either percutaneous portal vein embolization (PVE) or portal vein ligation (PVL) is routinely used to induce liver hypertrophy prior to major liver resection in patients with hepatic malignancy. While this increases the future liver remnant (FLR) and hence the number of patients suitable for resection, recent evidence suggests that induction of liver hypertrophy pre-operatively may promote tumour growth and increase recurrence rates. Aim of the current study is to evaluate the impact of PVE on hepatic recurrence rate and survival in patients with colorectal liver metastases (CRLM).Methods Medline, Embase and Web of Science databases were searched to identify studies assessing the oncological outcomes of patients undergoing major liver resection for CRLM following PVE. Studies comparing patients undergoing one stage liver resection with or without pre-operative PVE were included. The primary outcome was hepatic recurrence (HR). Secondary outcomes were 3- and 5-year overall survival (OS). Results Of the 2131 studies identified, six nonrandomized studies (n=668) met the eligibility criteria comparing outcomes of patients undergoing major liver resection with or without PVE (n=182 vs. n=486 respectively). The median follow-up time ranged from 23.5 to 46 months. There was no significant difference in HR (OR, 0.78; 95% CI, 0.42 to 1.44, p=0.41), 3-year OS (OR, 0.80; 95% CI, 0.56 to 1.14, p=0.22) or 5-year OS (OR, 1.12; 95% CI, 0.40 to 3.11, p=0.82). Conclusion PVE in patients with CRLM has no adverse effect on hepatic recurrence or overall survival following major liver resection.
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