Liver ischemia-reperfusion injury is a major cause of postoperative liver dysfunction,morbidity and mortality following liver resection and transplantation.Ischemic conditioning has been shown to ameliorate ischemiare...Liver ischemia-reperfusion injury is a major cause of postoperative liver dysfunction,morbidity and mortality following liver resection and transplantation.Ischemic conditioning has been shown to ameliorate ischemiareperfusion injury in small animal models.It can be applied directly or remotely when cycles of ischemia and reperfusion are applied to a distant site or organ.Considering timing of the procedure,different protocols are available.Ischemic preconditioning refers to that performed before the duration of ischemia of the target organ.Ischemic perconditioning is performed over the duration of ischemia of the target organ.Ischemic postconditioning applies brief episodes of ischemia at the onset of reperfusion following a prolonged ischemia.Animal studies pointed towards suppressing cytokine release,enhancing the production of hepatoprotective adenosine and reducing liver apoptotic response as the potential mechanisms responsible for the protective effect of direct tissue conditioning.Interactions between neural,humoral and systemic pathways all lead to the protective effect of remote ischemic preconditioning.Despite promising animal studies,none of the aforementioned protocols proved to be clinically effective in liver surgery with the exception of morbidity reduction in cirrhotic patients undergoing liver resection.Further human clinical trials with application of novel conditioning protocols and combination of methods are warranted before implementation of ischemic conditioning in day-to-day clinical practice.展开更多
Neuroendocrine neoplasms(NENs)of the gastroenteropancreatic system are rare and heterogeneous tumours,yet with increasing prevalence.The most frequent primary sites are the small intestine,rectum,pancreas,and stomach....Neuroendocrine neoplasms(NENs)of the gastroenteropancreatic system are rare and heterogeneous tumours,yet with increasing prevalence.The most frequent primary sites are the small intestine,rectum,pancreas,and stomach.For a localized disease,surgical resection with local lymph nodes is usually curative with good overall and disease free survival.More complex situation is the treatment of locally advanced lesions,liver metastases,and,surprisingly,small asymptomatic tumours of the rectum and pancreas.In this review,we focus on the current role of surgical management of gastroenteropancreatic NENs.We present surgical approach for the most frequent primary sites.We highlight the role of endoscopic surgery and the watch-and-wait strategy for selected cases.As liver metastases pose an important clinical challenge,we present current indications and contraindications for liver resection and a role of liver transplantation for metastatic NENs.展开更多
基金Supported by National Science Centre,Poland,No.2019/34/E/NZ5/00433.
文摘Liver ischemia-reperfusion injury is a major cause of postoperative liver dysfunction,morbidity and mortality following liver resection and transplantation.Ischemic conditioning has been shown to ameliorate ischemiareperfusion injury in small animal models.It can be applied directly or remotely when cycles of ischemia and reperfusion are applied to a distant site or organ.Considering timing of the procedure,different protocols are available.Ischemic preconditioning refers to that performed before the duration of ischemia of the target organ.Ischemic perconditioning is performed over the duration of ischemia of the target organ.Ischemic postconditioning applies brief episodes of ischemia at the onset of reperfusion following a prolonged ischemia.Animal studies pointed towards suppressing cytokine release,enhancing the production of hepatoprotective adenosine and reducing liver apoptotic response as the potential mechanisms responsible for the protective effect of direct tissue conditioning.Interactions between neural,humoral and systemic pathways all lead to the protective effect of remote ischemic preconditioning.Despite promising animal studies,none of the aforementioned protocols proved to be clinically effective in liver surgery with the exception of morbidity reduction in cirrhotic patients undergoing liver resection.Further human clinical trials with application of novel conditioning protocols and combination of methods are warranted before implementation of ischemic conditioning in day-to-day clinical practice.
文摘Neuroendocrine neoplasms(NENs)of the gastroenteropancreatic system are rare and heterogeneous tumours,yet with increasing prevalence.The most frequent primary sites are the small intestine,rectum,pancreas,and stomach.For a localized disease,surgical resection with local lymph nodes is usually curative with good overall and disease free survival.More complex situation is the treatment of locally advanced lesions,liver metastases,and,surprisingly,small asymptomatic tumours of the rectum and pancreas.In this review,we focus on the current role of surgical management of gastroenteropancreatic NENs.We present surgical approach for the most frequent primary sites.We highlight the role of endoscopic surgery and the watch-and-wait strategy for selected cases.As liver metastases pose an important clinical challenge,we present current indications and contraindications for liver resection and a role of liver transplantation for metastatic NENs.
