R.M. van Dam

Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection

Accelerated recovery from surgery has been achieved when patients are managed within a multimodal Enhanced Recovery After Surgery (ERAS) protocol. This study evaluated the benefit of an ERAS programme for patients undergoing liver resection.

Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection

Routine laxatives may expedite gastrointestinal recovery and early tolerance of food within an enhanced recovery after surgery (ERAS) programme. Combined with carbohydrate loading and oral nutritional supplements (ONS), it may further enhance recovery of gastrointestinal function and promote earlier overall recovery.

Feasibility of randomized controlled trials in liver surgery using surgery-related mortality or morbidity as endpoint

There is a shortage of randomized controlled trials (RCTs) on which to base guidelines in liver surgery. The feasibility of conducting an adequately powered RCT in liver surgery using the dichotomous endpoints surgery‐related mortality or morbidity was examined.

Development of a composite endpoint for randomized controlled trials in liver surgery

The feasibility of randomized controlled trials (RCTs) in liver surgery using a single‐component clinical endpoint is low as such endpoints require large sample sizes owing to their low incidence. A liver surgery‐specific composite endpoint (CEP) could solve this problem. The aim of this study was to develop a liver surgery‐specific CEP with well‐defined components.

Fibrin Sealant for Prevention of Resection Surface-Related Complications After Liver Resection: A Randomized Controlled Trial

Objective:To evaluate the efficacy of fibrin sealant in reducing resection surface-related complications in liver surgery. Background:Bile leakage, bleeding, and abscess formation are major resection surface-related complications after liver resection. It is unclear whether application of fibrin sealant to the resection surface is effective in reducing these complications. Methods:In a multicenter, randomized trial in 310 noncirrhotic patients undergoing liver resection, we compared prophylactic application of fibrin sealant to the resection surface (156 patients) with no application of fibrin sealant (154 patients). In addition to clinical assessments, patients underwent protocolized computerized tomography (CT) scan 1 week postoperatively. Primary endpoint was a composite of postoperative resection surface-related complications (bile leakage, bleeding, or abscess), as adjudicated by a clinical-events committee that was unaware of the study-group assignments. Results:Overall rate of resection surface-related complications was not different between the 2 groups: 24% (38/156 patients) in the fibrin sealant group and 24% (37/154 patients) in the control group. Bile leakage was detected in 14% of patients in the fibrin sealant group and in 14% of controls. CT scans showed a fluid collection at the resection surface 100 mL or more in 28% of patients in the fibrin sealant group and in 26% of controls (P = 0.800). The rate of reinterventions for resection surface-related complications (12% vs 10%; P = 0.492) and severity of complications did also not differ between the 2 groups. Conclusions:This randomized multicenter trial shows that prophylactic application of fibrin sealant at the resection surface after liver resections does not lead to a reduction in the incidence or severity of postoperative bile leakage or other resection surface-related complications (Controlled trial number, ISRCTN85205641).

Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study)

Laparoscopic left lateral sectionectomy (LLLS) has been associated with shorter hospital stay and reduced overall morbidity compared with open left lateral sectionectomy (OLLS). Strong evidence has not, however, been provided.

Patient‐derived organoid models help define personalized management of gastrointestinal cancer

The prognosis of patients with different gastrointestinal cancers varies widely. Despite advances in treatment strategies, such as extensive resections and the addition of new drugs to chemotherapy regimens, conventional treatment strategies have failed to improve survival for many tumours. Although promising, the clinical application of molecularly guided personalized treatment has proven to be challenging. This narrative review focuses on the personalization of cancer therapy using patient‐derived three‐dimensional ‘organoid’ models.

The Introduction of a Laparoscopic Liver Surgery Programme: A Cost Analysis of Initial Experience in a University Hospital

Background and Aims In the era of expanding costs of healthcare, this study was conducted to perform a cost analysis of introducing a laparoscopic liver surgery programme for left sided liver lesions. Materials and Methods Consecutive patients treated by laparoscopic liver resections of left lateral segments were included. Controls were a group of 14 patients undergoing open resection for similar pathology. Primary outcomes were costs. Secondary outcomes were complications, conversions, blood loss, length of operation, and length of hospital stay. Results The laparoscopic approach for hepatic left lateral resection (bisegmentectomy 2 and 3) was performed in fourteen patients (group I, median age 54 [range 26–82] years). In the open group, fourteen patients from a prospectively collected database with the same type of resection were selected (group II, median age 64 [range 29–76] years). Costs of theatre usage in the laparoscopic group were significantly lower (p = 0.031). No significant differences in costs of disposable instruments, ward stay and total costs were observed between the two groups. There were three complications in the laparoscopic group compared with two complications in the open group. In the laparoscopic group there were 2 conversions (14%). Median blood loss was significantly lower in the laparoscopic group (50 mls [range 0–750], (p = 0.001) versus the open group (500 mls [range 150–750]). Furthermore, operation time was also significantly lower in the laparoscopic group (116 [range 85–261] minutes) versus the open group (165 [range 96–217] minutes, p = 0.016). Median length of stay was 6 [range 4–11] days in group I versus 6 [range 5–13] days in group II (p = 0.508). Conclusion Costs of laparoscopic liver resections proved to be equivalent to open surgery. Furthermore, implementation of a laparoscopic liver resection programme seems feasible and safe with reduced blood loss and operation time and comparable morbidity and length of stay.

Effect of Age on Liver Function in Patients Undergoing Partial Hepatectomy

Background: Postresectional liver failure is the most frequent cause of fatal outcome following liver surgery. Diminished preoperative liver function in the elderly might contribute to this. Therefore, the aim of the present study was to evaluate preoperative liver function in patients <60 or >70 years of age scheduled for liver resection. Methods: All consecutive patients aged <60 or >70 years who are about to undergo elective liver surgery between 2011 and 2013 and underwent the methacetin breath liver function test (LiMAx) preoperatively were included. Histologic assessment of the resected liver gave insight into background liver disease. Correlation between age and liver function was calculated with Pearsons test. Results: Fifty-nine patients were included, 31 were aged <60 and 28 were aged >70 years. General patient characteristics and liver function LiMAx values (340 (137-594) vs. 349 (191-530) μg/kg/h, p = 0.699) were not significantly different between patients aged <60 and >70 years. Moreover, no correlation between age and preoperative liver function LiMAx values was found (R = 0.04, p = 0.810). Conclusion: Liver function did not seem to differ between younger and older patients.

Reduced survival in pancreatic cancer patients with low muscle attenuation index

Results Methods • CT-images of 192 patients from a prospective cohort (2008-2013) were analysed at the L3 level for area of muscle, visceral adipose tissue, subcutaneous adipose tissue, and intermuscular adipose tissue (Figure 1). Muscle area and visceral adipose tissue were corrected for stature to calculate the L3-index. • The Muscle Attenuation Index was measured as average Hounsfield units (HU) of the total muscle area at the L3 level. • Sex-specific cut-offs were chosen at the median and at tertiles to assess the effect of the different measurements on post-surgical outcomes.