Julie Hallet

Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives.

Pre‐operative simulation using three‐dimensional (3D) reconstructions have been suggested to enhance surgical planning of hepatectomy. Evidence on its benefits for hepatectomy patients remains limited. This systematic review examined the use and impact of pre‐operative simulation and intraoperative navigation on hepatectomy outcomes. A systematical searched electronic databases for studies reporting on the use and results of simulation and navigation for hepatectomy was performed. The primary outcome was change in operative plan based on simulation. Secondary outcomes included operating time (min), estimated blood loss, surgical margins, 30‐day postoperative morbidity and mortality, and study‐specific outcomes. From 222 citations, we included 11 studies including 497 patients. All were observational cohort studies. No study compared hepatectomy with and without simulation. All studies performed 3D reconstruction and segmentation, most commonly with volumetrics measurements. In six studies reporting intraoperative navigation, five relied on ultrasound, and one on a resection map. Of two studies reporting on it, the resection line was changed intraoperatively in one third of patients, based on simulation. Virtually predicted liver volumes (Pearson correlation r = 0.917 to 0.995) and surgical margins (r = 0.84 to 0.967) correlated highly with actual ones in eight studies. Heterogeneity of the included studies precluded meta‐analysis.Pre‐operative simulation seems accurate in measuring volumetrics and surgical margins. Current studies lack intraoperative transposition of simulation for direct navigation. Simulation appears useful planning of hepatectomies, but further work is warranted focusing on the development of improved tools and appraisal of their clinical impact compared to traditional resection.

Trans-Thoracic Minimally Invasive Liver Resection Guided by Augmented Reality

Received October 21, 2014; Revised December 30, 2 December 30, 2014. From the Institut Hospitalo-Universitaire (IHU), Institute Hybrid Invasive Image-Guided Surgery, Université de Stra Soler, Mutter, Marescaux, Pessaux); the Institut de Recherc cers de l’Appareil Digestif (IRCAD) (Hallet, Soler, Diana mert, Marescaux, Pessaux); the General Digestive and End Service, Nouvel Hôpital Civil (Mutter, Baumert, Habers Strasbourg, France; and the Division of General Surger Health Sciences Centre e Odette Cancer Centre, Toronto, ada (Hallet). Correspondence address: Patrick Pessaux, MD, PhD, 1 Pla 67091, Strasbourg, France. email: patrick.pessaux@chru-str

Factors influencing recurrence following initial hepatectomy for colorectal liver metastases

Data on recurrence patterns following hepatectomy for colorectal liver metastases (CRLMs) and their impact on long‐term outcomes are limited in the setting of modern multimodal management. This study sought to characterize the patterns of, factors associated with, and survival impact of recurrence following initial hepatectomy for CRLMs.

Pasireotide for the Prevention of Pancreatic Fistula Following Pancreaticoduodenectomy: A Cost-effectiveness Analysis

Objective: To determine the cost-effectiveness of perioperative administration of pasireotide for reduction of pancreatic fistula (PF). Summary: PF is a major complication following pancreaticoduodenectomy (PD), associated with significant morbidity and healthcare-related costs. Pasireotide is a novel multireceptor ligand somatostatin analogue, which has been demonstrated to reduce the incidence of PF following pancreas resection; however, the drug cost is significant. This study sought to estimate the cost-effectiveness of routine administration of pasireotide to patients undergoing PD, compared with no intervention from the perspective of the hospital system. Methods: A decision-analytic model was developed to compare costs for perioperative administration of pasireotide versus no pasireotide. The model was populated using an institutional database containing all PDs performed 2002 to 2012 at a single institution, including data regarding clinically significant PF (International Study Group on Pancreatic Fistula Grade B or C) and hospital-related inpatient costs for 90 days following PD, converted to 2014

Short and long-term outcomes of laparoscopic compared to open liver resection for colorectal liver metastases

USD. Relative risk of PF associated with pasireotide was estimated from the published literature. Deterministic and probabilistic sensitivity analyses were performed to test robustness of the model. Results: Mean institutional cost of index admissions was

Laparoscopic Intragastric Resection: An Alternative Technique for Minimally Invasive Treatment of Gastric Submucosal Tumors

67,417 and

Critical appraisal of predictive tools to assess the difficulty of laparoscopic liver resection: a systematic review

31,950 for patients with and without PF, respectively. Pasireotide was the dominant strategy, associated with savings of

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy

1685, and a mean reduction of 1.5 days length of stay. Univariate sensitivity analyses demonstrated cost-savings down to a PF rate of 5.6%, up to a relative risk of PF of 0.775, and up to a drug cost of

ASO Author Reflections: Cytoreduction for Extrahepatic Metastatic Neuroendocrine Tumors

2817. Probabilistic sensitivity analysis showed 79% of simulations were cost saving. Conclusions: Pasireotide appears to be a cost-saving treatment following PD across a wide variation of clinical and cost scenarios.

Re: Secondary gastric cancer following a breast cancer diagnosis; beware of metastatic breast cancer

BACKGROUND Minimally invasive surgery (MIS) is now established as standard of care for a variety of gastrointestinal procedures for benign and malignant indications. However, due to concerns regarding superiority to open liver resection (OLR), the uptake of laparoscopic liver resection (LLR) has been slow. Data on long-term outcomes of LLR for colorectal liver metastases (CRLM) remain limited. We conducted a systematic review and meta-analysis of short and long-term outcomes of LLR compared to OLR for CRLM. METHODS Five electronic databases were systematically searched for studies comparing LLR and OLR for CRLM and reporting on survival outcomes. Two reviewers independently selected studies and extracted data. Primary outcomes were overall survival (OS) and recurrence free survival (RFS). Secondary outcomes were operative time, estimated blood loss, post-operative major morbidity, mortality, length of stay (LOS), and resection margins. RESULTS Eight non-randomized studies (NRS) were included (n=2,017 total patients). Six were matched cohort studies. LLR reduced estimated blood loss [mean difference: -108.9; 95% confidence interval (CI), -214.0 to -3.7) and major morbidity [relative risk (RR): 0.68; 95% CI, 0.56-0.83], but not mortality. No difference was observed in operative time, LOS, resection margins, R0 resections, and recurrence. Survival data could not be pooled. No studies reported inferior survival with LLR. OS varied from 36% to 60% for LLR and 37% to 65% for OLR. RFS ranged from 14% to 30% for LLR and 22% to 38% for OLR. According to the grade classification, the strength of evidence was low to very low for all outcomes. The use of parenchymal sparing resections with LLR and OLR could not be assessed. CONCLUSIONS Based on limited retrospective evidence, LLR offers reduced morbidity and blood loss compared to OLR for CRLM. Comparable oncologic outcomes can be achieved. Although LLR cannot be considered as standard of care for CRLM, it is beneficial for well-selected patients and lesions. Therefore, LLR should be part of the liver surgeons armamentarium.