S Wabitsch

Validity of the Iwate criteria for patients with hepatocellular carcinoma undergoing minimally invasive liver resection

Recently proposed by the International Consensus Conference on Laparoscopic Liver Resection, the Iwate criteria (IC) can be used by surgeons to predict the operative difficulty of laparoscopic liver resection (LLR) and were validated in patients with hepatocellular carcinoma (HCC), the most common indication for LLR.

Single-Incision Laparoscopic Liver Resection in Ruptured Liver Adenoma

Introduction: Spontaneous rupture of liver tumors, such as hepatocellular adenoma (HCA) and carcinoma (HCC), is rare, but may be life threatening, as unspecific symptoms can be misleading. Immediate diagnosis, angiographic intervention and surgery is needed to stop the bleeding. Case Description: We present a case of a ruptured HCA, which was addressed by a 2-step interventional and laparoscopic approach. A female 53-year-old patient was admitted to the hospital with unspecific epigastric pain for the past 3 days. Acute coronary syndrome was initially suggested because of a history of hypertension, but could be ruled out in further investigation. Ultrasonography and a subsequent contrast-enhanced computed tomographic (CT) scan of the abdomen showed a massive deterioration of the left-lateral section, with active bleeding from a ruptured liver tumor and free-floating blood in the peritoneal cavity. Successful emergency angiographic embolization was accomplished with gelatin foam powder (Gelita-Spon, Gelita Medical, Germany) in the hemodynamically stable patient. Subsequent magnetic imaging (MRI) with the hepatospecific contrast agent gadoxetate sodium (Gd-EOB or Primovist/Eovist; Bayer, Leverkusen, Germany) revealed the most likely diagnosis of an HCA, which had been ruptured. Two additional adenomas 3 cm in diameter in liver segments 4 and 6 were diagnosed without the need for further treatment. We performed a single-incision laparoscopy to evacuate the hematoma and to address the ruptured liver tumor. Anatomic left lateral sectionectomy was performed with a harmonic scalpel and a vascular stapler. The resected liver lobe was removed through the umbilical single-port incision. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Discussion: This case emphasizes the importance of interdisciplinary management of ruptured liver tumors and highlights advantages of single-incision laparoscopy over laparotomy in the management of emergency liver resection.

Minimal-invasive versus open hepatectomy for hepatocellular carcinoma: Comparison of postoperative outcomes and long-term survivals using propensity score matching analysis

BACKGROUNDnMinimal-invasive hepatectomy (MIH) has been increasingly performed for benign and malignant liver lesions with most promising results. However, the role of MIH for the treatment of patients with hepatocellular carcinoma (HCC) needs further investigation.nnnMETHODSnClinicopathological data of patients who underwent liver resection for HCC between 2005 and 2016 were assessed. Postoperative outcomes und long-term survivals of patients following MIH were compared with those of patients undergoing conventional open hepatectomy (OH) after 1:1 propensity score matching.nnnRESULTSnDuring the study period, 407 patients underwent liver resection for HCC with curative intent. Fifty-six patients underwent MIH and were compared with a matched cohort of 56 patients who underwent OH. The rate of patients with fibrosis/cirrhosis (82% vs. 86%, pu202f=u202f0.959), multiple lesions (32% vs. 32%, pu202f=u202f1.00), tumor size >30u202fmm (61% vs. 55%, pu202f=u202f0.566), and major resection (16% vs. 16%, pu202f=u202f1.00) was comparable between the two groups (MIH vs. OH). MIH was associated with lower 90-day complication rate (32% vs. 54%, pu202f=u202f0.022), lower postoperative major complication rate (14% vs. 30%, pu202f=u202f0.041), lower liver failure rate (0% vs. 7%, pu202f=u202f0.042), lower 90-day mortality rate (0 vs. 7%, pu202f=u202f0.042), and shorter length of hospital stay (9 vs. 12 days, pu202f=u202f0.009) compared to OH. After a median follow-up time of 51 months, MIH and OH showed comparable 5-year overall survival (54% vs. 41%, pu202f=u202f0.151), and 5-year disease-free survival rates (50% vs. 38%, pu202f=u202f0.956).nnnCONCLUSIONSnMIH for HCC is associated with lower postoperative morbidity and mortality and shorter length of hospital stay, resulting in oncologic outcomes similar to those achieved with the established OH. Our findings suggest that MIH should be considered as the preferred method for the treatment of curatively resectable HCC.

The nanomolar sensing of nicotinamide adenine dinucleotide in human plasma using a cycling assay in albumin modified simulated body fluids

Nicotinamide adenine dinucleotide (NAD), a prominent member of the pyridine nucleotide family, plays a pivotal role in cell-oxidation protection, DNA repair, cell signalling and central metabolic pathways, such as beta oxidation, glycolysis and the citric acid cycle. In particular, extracellular NAD+ has recently been demonstrated to moderate pathogenesis of multiple systemic diseases as well as aging. Herein we present an assaying method, that serves to quantify extracellular NAD+ in human heparinised plasma and exhibits a sensitivity ranging from the low micromolar into the low nanomolar domain. The assay achieves the quantification of extracellular NAD+ by means of a two-step enzymatic cycling reaction, based on alcohol dehydrogenase. An albumin modified revised simulated body fluid was employed as standard matrix in order to optimise enzymatic activity and enhance the linear behaviour and sensitivity of the method. In addition, we evaluated assay linearity, reproducibility and confirmed long-term storage stability of extracellular NAD+ in frozen human heparinised plasma. In summary, our findings pose a novel standardised method suitable for high throughput screenings of extracellular NAD+ levels in human heparinised plasma, paving the way for new clinical discovery studies.

Health-related quality of life after laparoscopic liver resection

BACKGROUNDnPotential benefits of laparoscopic liver resections (LLRs) over open liver resections (OLRs) such as the clinical outcome and health-related quality of life (HRQoL) have not convincingly been investigated, yet.nnnPATIENTS AND METHODSnAll patients who had undergone LLR and OLR at our department between 1 June 2014 and 10 October 2016 were identified. HRQoL was assessed using the short form 36 (SF-36). All patients who returned the surveys were then retrospectively analysed with regards to the perioperative outcome.nnnRESULTSnWe received 66 eligible questionnaires (50%). The number of major liver resections did not significantly differ between both groups (LLR: 11 [33%], OLR: 16 [48%], P = 0.211).The proportion of patients with two or more co-morbidities (P = 0.044) and liver cirrhosis (P = 0.016), respectively, was significantly higher in the LLR group, when compared to the OLR group (LLR: 11 [33%] vs. 3 of 33 patients [9%], P = 0.016). HRQoL scores were good with no significant differences between both groups. Among these patients, there were significantly more pulmonary complications in the OLR group, and length of hospital stay was longer when compared to the LLR group.nnnCONCLUSIONSnLaparoscopic liver surgery can be performed safely even in multimorbid elderly patients resulting in high HRQoL scores.