Y. Wakasa

Cancer-positive surgical margins as a risk factor for biloma, infectious complications, and hepatic insufficiency after extensive hepatobiliary resection

University of Sao Paulo School of Medicine, and University of Sao Paulo School of Medicine, Brazil Laparoscopic cholecystectomy is the gold standard treatment of cholelithiasis. Elderly patients are more susceptible to gallbladder disease and acute cholecystitis. Nevertheless they appear to be undertreated compared to younger patients, mainly due to the fear of postoperative complications. We aimed to evaluate outcome of laparoscopic cholecystectomy (LC) in elderly patients according to the preoperative Comorbidity Combined Score (CCS). Methods: We retrospectively evaluated 537 patients over 60 years of age submitted to LC from 2008 to 2015. Patients were divided in low CCS, CCS 0, and high CCS groups. CCS was calculated according to Gagne JJ et al. (J Clin Epidemiol, 2011). Results: Age was 67.93 6.75y, 65.92% women. Patients of Low-CCS group (n = 344) showed increased number of women (70.93% vs. 57.49%), decreased age (67.38 6.17 vs. 68.90 7.35 y), Karnofsky score [90(50e100) vs. 90(40e100)], ASA score [2(1e3) vs. 2(1e4)], length of hospital [4(0e48) vs. 6 (1e50) days] and ICU [3 (1e7) vs. 3(2e20)days] stay, patients admitted to ICU (5.8% vs. 21.2%), and patients with postoperative complications (25.8% vs. 35.9%) compared to High-CCS group (n = 193). There was no difference in incidence of major complications according to Clavien-Dindo Classification in LowCCS compared to High-CCS group, but early postoperative death was significantly higher in High-CCS group (2.59% vs. 0.29%). Conclusions: CCS score can predict higher risk of morbimortality of elderly patients submitted to LC. Patients with high CCS must have careful preoperative evaluation and greater flexibility for indication of ICU admission.

Living-Donor Liver Transplantation With the Use of a Left-Lobe Graft From a Donor With Anomalous Biliary Anatomy in Which B4 Joins the Right Anterior Sectional Duct: A Case Report

When there is an anatomic anomaly in the biliary tract of the donor for living-donor liver transplantation, the risk of postoperative biliary tract complications increases in both the donor and the recipient. We studied a case of living-donor liver transplantation with a left hepatic lobe graft that had anatomic anomalies, in which the medial segmental branch (B4) joined the anterior segmental branch and the posterior segmental branch formed a common trunk with the lateral segmental branch. A 40-year-old man visited our institution as a candidate organ donor for his mother, who had end-stage liver failure. An anomaly of B4 connecting the anterior segmental branch was suspected on magnetic resonance cholangiopancreatography. On intraoperative cholangiography, confluence of B4 with the anterior segmental branch and connection of the posterior and lateral segmental branches forming a common trunk were confirmed. Accordingly, individual anastomoses of the lateral segmental branch and B4 with the recipient jejunum were planned, and a left-lobe graft was excised. The postoperative recovery was smooth, and the donor was discharged with no complications. Even when an anatomic anomaly is present in the donor bile duct, in urgent cases, accurate evaluation through the use of various modalities may enable living-donor liver transplantation with the use of a graft with an anatomic anomaly.

Effect of bevacizumab on the development of oxaliplatin-associated liver injury in colorectal cancer liver metastasis

recurrence p = 0.018; liver recurrence p = 0.03). There was no difference in the incidence of any or local recurrences between RM1e5mm (p = 0.445) and 5e10mm (p = 0.837). The presence of synchronous disease demonstrated a trend towards liver recurrences only (p = 0.053) but did not reach statistical significance. On multivariate analysis, only R1 affected the incidence of liver recurrence (p = 0.019) but not overall recurrence (p = 0.087). Conclusion: R1 resection is associated with increased recurrence in the liver irrespective of chemotherapy use. There is no difference in recurrence between resection margins1e5mm and 5e10mm.