Repeated laparoscopic liver resection using ICG fluorescent imaging for recurrent liver cancer

Objective:Liver cancer is very common in China,with cumulative five-year tumor recurrence rate after a microscopically margin-negative resection of hepatocellular carcinoma up to 70%.Postoperative recurrent hepatocellular carcinoma presents a challenge for surgeons because of the complexity of postoperative adhesion and the difficulty in of recognizing recurrent lesions.This study aims to introduce a method using an indocyanine green(ICG)fluorescent imaging technique to do repeated laparoscopic liver resection.Method:Patients received repeated laparoscopic liver resection using ICG fluorescent imaging between January 2017 and December 2019 in the Department of General Surgery of Sir Run Run Shaw Hospital were analyzed retrospectively.Basic information,intraoperative information,complications,and followup time were collected and analyzed.Results:Totally,35 patients with a median age of 59 years(ranged 38-82 years)were included.All of the patients received minimally invasive surgery.One case was performed robotically,and only two cases were converted to open surgery due to severe adhesion.The median operating time was 174 minutes,and the median blood loss during surgery was 100 mL.The median hospital stay after surgery was 5 days,with a range of 3e55 days.In total,32(91.4%)patients showed staining by ICG fluorescent imaging,and lesions were visible on fluorescent camera.The median follow-up time was 19.7 months,with a range of 1e40.2 months.The median relapse-free survival time was 18.5 months.Conclusion:Repeated laparoscopic liver resection using ICG fluorescent imaging is a safe and promising approach in the treatment of recurrent liver tumors in selected patients.

The effect of cholecystectomy on the risk of colorectal cancer:A systematic review and meta-analysis

Objective:Some studies have found that cholecystectomy may increase the risk of colorectal cancer(CRC),while others have reached inconsistent conclusions.We thus performed a systematic review and meta-analysis to assess the incidence rate of CRC after cholecystectomy for patients with gallstones or gallbladder diseases,and whether the geographical location of the patients affected the results.Methods:We systematically searched PubMed,Embase,and Cochrane for studies reporting changes in the incidence rate of CRC after cholecystectomy published before January 12,2023.Our main endpoint wasthe occurrence of CRC Data were extracted and pooled,and the relative risk(RR)and 95%confidence interval(CI)were calculated.We assessed pooled data using a random-effects model.Results:In total,477 articles were identifled,and 6 articles were eligible,including 7 studies thatincluded 797,917 participants.Overall,the summarized research results showed that the risk of CRC was reduced in patients with gallbladder diseases who underwent cholecystectomy(RR:0.80,95%C:0.65 to0.99,p=0.040;I^(2)=85.0%).In the subgroup analysis based on different geographical locations,chole-cystectomy was not associated with the nisk of CRC in the Western population(RR:0.90,95%C:0.65 to 1.25.p=0.522;I^(2)=86.5%),but there was a negative corelation between cholecystectomy and the risk of CRC(RR:0,66,95%Cl:0.60 to 0,73,p=0.000)in the Chinese population Conclusions:Our findings support that for patients with gallstones or gallbladder diseases,the incidence of CRC after cholecystectomy is lower than that of patients who do not undergo cholecystectomy.

A novel scoring system for conversion and complication in laparoscopic liver resection

Background:Although laparoscopic liver resection(LLR)has been increasingly popular worldwide,there is lack of predictive model to evaluate the feasibility and safety of LLR.The aim of this study was to establish a scoring system for predicting the possibility of conversion and complication,which could facilitate the patient selection for clinicians and communication with patients and their relatives during the informed consent process.Methods:Consecutively 696 patients between August 1998 and December 2016 underwent LLR were recruited.The entire cohort was divided randomly into development and validation cohorts.The scoring system for conversion and complication were established according to risk factors identified from multiple logistic analysis.Subgroup analysis was performed to assess the clinical application.And the C-index and decision curve analysis(DCA)were conducted to evaluate the discrimination in comparison with other predictive models.Results:Six hundred and ninety-six patients were enrolled eventually.The rate of conversion in the development and validation cohorts was 8.3%and 10.3%,respectively.Compared with 12.6%complication rate in the development cohort,12.9%was concluded in the validation cohort.Upon on the identified risk factors,the risk stratification model was established and validated.Subsequent subgroup analysis indicated low risk patients presented superior surgical outcomes compared with high risk patients.Besides,the C-index and DCA implied our models had better capacities of predicting conversion and complication in comparison with previous scoring systems.Conclusions:This novel scoring system presents the remarkable capacities of predicting conversion,complication in LLR.And thereby,it could be a useful instrument to facilitate the patient selection for clinicians and communication with patients and their relatives during the informed consent process.