Laparoscopic liver resection for colorectal liver metastases—shortand long-term outcomes:A systematic review

BACKGROUND For well-selected patients and procedures,laparoscopic liver resection(LLR)has become the gold standard for the treatment of colorectal liver metastases(CRLM)when performed in specialized centers.However,little is currently known concerning patient-related and peri-operative factors that could play a role in survival outcomes associated with LLR for CRLM.AIM To provide an extensive summary of reported outcomes and prognostic factors associated with LLR for CRLM.METHODS A systematic search was performed in PubMed,EMBASE,Web of Science and the Cochrane Library using the keywords“colorectal liver metastases”,“laparoscopy”,“liver resection”,“prognostic factors”,“outcomes”and“survival”.Only publications written in English and published until December 2019 were included.Furthermore,abstracts of which no accompanying full text was published,reviews,case reports,letters,protocols,comments,surveys and animal studies were excluded.All search results were saved to Endnote Online and imported in Rayyan for systematic selection.Data of interest were extracted from the included publications and tabulated for qualitative analysis.RESULTS Out of 1064 articles retrieved by means of a systematic and grey literature search,77 were included for qualitative analysis.Seventy-two research papers provided data concerning outcomes of LLR for CRLM.Fourteen papers were eligible for extraction of data concerning prognostic factors affecting survival outcomes.Qualitative analysis of the collected data showed that LLR for CRLM is safe,feasible and provides oncological efficiency.Multiple research groups have reported on the short-term advantages of LLR compared to open procedures.The obtained results accounted for minor LLR,as well as major LLR,simultaneous laparoscopic colorectal and liver resection,LLR of posterosuperior segments,twostage hepatectomy and repeat LLR for CRLM.Few research groups so far have studied prognostic factors affecting long-term outcomes of LLR for CRLM.CONCLUSION In experienced hands,LLR for CRLM provides good short-and long-term outcomes,independent of the complexity of the procedure.

Potential importance of early treatment of SARS-CoV-2 infection in intestinal transplant patient: A case report

BACKGROUND Predispositions for severe coronavirus disease 2019(COVID-19)are age,immunosuppression,and co-morbidity.High levels of maintenance immunosuppression render intestinal transplant(ITx)patients vulnerable for severe COVID-19.COVID-19 also provokes several gastroenterological pathologies which have not been discussed in ITx,so far.CASE SUMMARY During the second European COVID-19 wave in November 2020,an ITx recipient was admitted to the hospital because of electrolyte disturbances due to dehydration.Immunosuppression consisted of tacrolimus,azathioprine,and low-dose corticosteroids.During hospitalization,she tested positive on screening COVID-19 nasopharyngeal polymerase chain reaction swab,while her initial test was negative.She was initially asymptomatic and had normal inflammatory markers.Tacrolimus levels were slightly raised,as Azathioprine was temporarily halted.Due to elevated Ddimers at that time,prophylactic low-molecular weight heparin was started.Seven days after the positive test,dyspnea,anosmia,and C-reactive protein increase(25 mg/L)were noted.Remdesivir was administered during 5 d in total.High stomal output was noted in two consecutive days and several days thereafter.To exclude infection or rejection,an ileoscopy and biopsy were performed and excluded these.Four weeks later,she was discharged from the hospital and remains in good health since then.CONCLUSION Early eradication of severe acute respiratory syndrome coronavirus 2 in ITx recipients may be warranted to prevent acute rejection provocation by it.