Abstract:
OBJECTIVE:To clarify the optimal surgical strategy for Bismuth type I and II hilar cholangiocarcinomas. SUMMARY BACKGROUND DATA:Local or hilar resections is often performed for Bismuth type I and II tumors; however, reported outcomes have been unsatisfactory with a high recurrence and low survival rate. To improve survival, some authors have recommended right hepatectomy. However, the clinical value of this approach has not been validated. METHODS:Records of 54 consecutive patients who underwent resection of a Bismuth type I or II hilar cholangiocarcinoma were analyzed retrospectively. Through 1996, bile duct resection or the smallest necessary hepatic segmentectomy was performed. Beginning in 1997, choice of resection was based on the cholangiographic tumor type. For nodular or infiltrating tumor, right hepatectomy was indicated; for papillary tumor, bile duct resection with or without limited hepatectomy was chosen. RESULTS:Right hepatectomy was performed in 5 (20.8%) of 24 patients through 1996 and was done in 22 (73.3%) of 30 patients from 1997 (P = 0.0003). In patients without pM1 disease, R0 resection was achieved more frequently in the later period than in the earlier period (23 of 24 = 95.8% vs. 13 of 21 = 61.9%, P = 0.0073), which lead to better survival (5-year survival, 44.3% vs. 25.0%, P = 0.0495). In the 31 patients with nodular or infiltrating tumor, who tolerated surgery and did not have pM1 disease, survival was better in the 18 patients who underwent right hepatectomy than in those who did not (5-year survival, 62.9% vs. 23.1%, P = 0.0030). In cases of papillary tumor, bile duct resection with or without limited hepatectomy was sufficient to improve long-term survival. CONCLUSIONS:The surgical approach to Bismuth type I and II hilar cholangiocarcinomas should be determined according to cholangiographic tumor type. For nodular and infiltrating tumors, right hepatectomy is essential; for papillary tumor, bile duct resection with or without limited hepatectomy is adequate.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Ikeyama T,Nagino M,Oda K,Ebata T,Nishio H,Nimura Ydoi
10.1097/SLA.0b013e318142d97esubject
Has Abstractpub_date
2007-12-01 00:00:00pages
1052-7issue
6eissn
0003-4932issn
1528-1140pii
00000658-200712000-00020journal_volume
246pub_type
杂志文章abstract::One hundred patients with intraabdominal infections were assigned randomly in double-blind fashion to receive either the combination of tobramycin plus clindamycin (TM/C) or moxalactam (MOX) alone. Fifty patients comprised each group, but one patient in each group died of infection before 48 hours treatment. In the re...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-198307000-00007
更新日期:1983-07-01 00:00:00
abstract::Metoclopramide or placebo was administered postoperatively in a randomized, double-blind fashion to 115 patients undergoing laparotomy. The effect of metoclopramide on postoperative adynamic ileus (PAI) was evaluated. The patients were stratified into two groups: Group A--those with laparotomy without a gastrointestin...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-197907000-00006
更新日期:1979-07-01 00:00:00
abstract:OBJECTIVE:To determine the proportion of registered trials published in the surgical literature, to compare, in registered trials, the primary outcomes registered with those published and to determine whether outcome-reporting bias favored significant primary outcomes. BACKGROUND:Trial protocol registration before pat...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318299d00b
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVE:To analyze the utility of quick intraoperative parathyroid hormone (PTH) measurement in the surgical management of primary hyperparathyroidism. BACKGROUND DATA:The use of intraoperative PTH monitoring is well established in the surgery of primary hyperparathyroidism. However, some false-negative predictions ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000145927.29265.8a
更新日期:2004-12-01 00:00:00
abstract:BACKGROUND:Gastrectomy remains a major operation with potential for significant deterioration in patients' health-related quality of life (QOL). This study assessed differences in QOL among patients after distal (DG), proximal (PG), or total (TG) gastrectomy. METHODS:We prospectively enrolled patients undergoing gastr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31828c4a19
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:Evaluate current risk factors for mortality and morbidity in patients undergoing the Fontan procedure at a single institution in the current era. SUMMARY BACKGROUND DATA:An emphasis on early relief of volume and pressure overload culminating in the Fontan procedure has improved patient outcomes for patients ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181858286
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:The "surgical personality" is a mostly negative academic and cultural image of the surgeon as egotistical, paternalistic, and inflexible. Because of this image, surgeons have been viewed as resistant to change and some behaviors, vulnerability, for example, are viewed as "suspect" because they seemingly thre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003707
更新日期:2019-12-02 00:00:00
abstract:OBJECTIVE:Determine whether absorbable or nonabsorbable mesh in repair of large hiatus hernias reduces the risk of recurrence, compared with suture repair. BACKGROUND:Repair of large hiatus hernia is associated with radiological recurrence rates of up to 30%, and to improve outcomes mesh repair has been recommended. P...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0000000000000842
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVE:To examine the surgical and pathologic findings of 15 patients who had initially unresectable hepatocellular carcinoma (HCC) and received preoperative systemic chemoimmunotherapy and sequential resection. SUMMARY BACKGROUND DATA:More than 80% of patients with HCC present for treatment at an unresectable stag...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200102000-00013
更新日期:2001-02-01 00:00:00
abstract::The development of effective, non-toxic (local and systemic) methods for the rapid chemical (enzymatic and non-enzymatic) debridement of third degree burns would dramatically reduce the morbidity and mortality of severely burned patients. Sepsis is still the major cause of death of patients with extensive deep burns. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197410000-00032
更新日期:1974-10-01 00:00:00
abstract:OBJECTIVE:To investigate the correlation between in-hospital surgical delay before appendectomy for suspected appendicitis and the finding of perforated appendicitis in children. METHODS:All children undergoing acute appendectomy for suspected acute appendicitis at Karolinska University Hospital, Stockholm, Sweden fro...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001694
更新日期:2017-03-01 00:00:00
abstract::The management of penetrating colon injury has been frequently debated in the literature, yet few reports have evaluated primary closure versus diverting colostomy in similarly injured patients. Diverting colostomy is the standard of care when mucosal penetration is present, but primary closure in civilian practice ha...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198904000-00009
更新日期:1989-04-01 00:00:00
abstract:OBJECTIVE:The purpose of this study is to use updated data and Bayesian methods to evaluate the effectiveness of hyperoxia to reduce surgical site infections (SSIs) and/or mortality in both colorectal and all surgery patients. Because few trials assessed potential harms of hyperoxia, hazards were not included. BACKGRO...
journal_title:Annals of surgery
pub_type: 杂志文章,meta分析
doi:10.1097/SLA.0b013e31826cc8da
更新日期:2012-12-01 00:00:00
abstract::A multivariate analysis of 30 preoperative risk factors was undertaken in 248 patients who underwent surgery alone for common bile duct (CBD) stones and in 190 patients who had endoscopic sphincterotomy (ES), 77 of whom subsequently also had surgery. Independently significant risk factors in those undergoing surgery w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198902000-00004
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVE:To determine whether insulinlike growth factor-I (IGF-I) and hepatocyte growth factor (HGF) cooperate to induce migration and invasion of human colorectal carcinoma (CRC) cells and whether the effects of IGF-I and/or HGF are mediated through activation of the urokinase plasminogen activator (uPA)/uPA receptor...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000160699.59061.92
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:To test whether frailty, a novel measure of physiologic reserve, is associated with longer kidney transplant (KT) length of stay (LOS), and modifies the association between LOS and mortality. BACKGROUND:Better understanding of LOS is necessary for informed consent and discharge planning. Mortality resulting ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002025
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the efficacy of remote ischemic conditioning (RIC) on organ protection after hemorrhagic shock/resuscitation (S/R) in a murine model. BACKGROUND:Ischemia/reperfusion resulting from S/R contributes to multiple organ dysfunction in trauma patients. We hypothesized that RIC before shock (remote isch...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000877
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVES:Immediate breast reconstruction (IBR) after mastectomy for cancer has increased in recent years, yet long-term, modality-specific comparative data are lacking. We performed this study to compare short- and long-term outcomes after expander, autologous (AT), and direct-to-implant (DI) breast reconstruction. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001457
更新日期:2015-10-01 00:00:00
abstract::Computed tomography and, to a lesser extent, ultrasonography provide detailed anatomic localization of intra-abdominal abscesses that permit precise percutaneous placement of catheters large enough to effect drainage. Using routes similar to surgical approaches, the authors have used this technique as definitive thera...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198110000-00014
更新日期:1981-10-01 00:00:00
abstract:OBJECTIVE:These studies were designed to elucidate the mechanism by which signals delivered by anti-CD2 monoclonal antibody (MoAb) interfere with activational signals delivered by anti-CD3 MoAb and induce long-term graft survival and tolerance. SUMMARY BACKGROUND DATA:Anti-CD2 or anti-CD3 MoAb can prolong allograft su...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199310000-00009
更新日期:1993-10-01 00:00:00
abstract::This study was conducted to elucidate plasma cholecystokinin (CCK) and pancreatic polypeptide (PP) response after pancreatoduodenectomy and to compare response of CCK and PP in patients who had pancreatoduodenectomy with Billroth I and Billroth II type of reconstruction. Basal levels of plasma CCK were significantly l...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198708000-00006
更新日期:1987-08-01 00:00:00
abstract::Obesity hypoventilation syndrome (OHS), defined as a PaO2 less than or equal to 55 mmHg and/or PaCo2 greater than or equal to 47 mmHg, was found in approximately 8% of morbidly obese patients undergoing gastric surgery for morbid obesity and was frequently associated with clinically significant pulmonary hypertension ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198805000-00015
更新日期:1988-05-01 00:00:00
abstract:BACKGROUND:Postcholecystectomy complex bile duct injuries involving the hilar confluence, which are often associated with vascular injuries and liver atrophy, remain a considerable surgical challenge. The aim of this study is to report our experience of major hepatectomy with long-term outcome in these patients. METHO...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31817b65f2
更新日期:2008-07-01 00:00:00
abstract::Ventral anomalies of accessory pulmonary tissue have been classified as "bronchopulmonary foregut malformations." Between July 1, 1981, and May 31, 1985, 10 children with bronchopulmonary malformations have been cared for on the Pediatric Surgical Service at the University of Virginia. Six patients had bronchogenic cy...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198605000-00011
更新日期:1986-05-01 00:00:00
abstract::Metabolic changes in six severely affected tetanus patients suffering from characteristic labile hypertension (maximum systolic blood pressure greater than 200 mmHG, maximum diurnal change in systolic pressure greater than 100 mmHg) were investigated. Daily urinary excretion of urea nitrogen increased gradually from t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199101000-00011
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:The aim of this prospective study was to determine incidence, duration, and risk factors for postoperative delirium (PD) in elderly patients undergoing major abdominal surgery. SUMMARY BACKGROUND DATA:The incidence and risk factors of PD after major abdominal surgery in elderly patients are not well document...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181c1cfc9
更新日期:2010-04-01 00:00:00
abstract:OBJECTIVE:To determine whether surgical subspecialty training in colorectal surgery or frequency of rectal cancer resection by the surgeon are independent prognostic factors for local recurrence (LR) and survival. SUMMARY BACKGROUND DATA:Variation in patient outcome in rectal cancer has been shown among centers and am...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/00000658-199802000-00001
更新日期:1998-02-01 00:00:00
abstract:OBJECTIVE:This study evaluates the effects of mechanical bowel preparation (MBP) on anastomosis below the peritoneal verge and questions the influence of MBP on anastomotic leakage in combination with a diverting ileostomy in lower colorectal surgery. SUMMARY BACKGROUND DATA:In a previous large multicenter randomized ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181c0e75c
更新日期:2010-01-01 00:00:00
abstract::The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and v...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199207000-00006
更新日期:1992-07-01 00:00:00
abstract::This study determines the infiltration rate of proximal and distal margins of resection in patients operated on for gastric cancer at the Istituto Nazionale Tumori of Milan. Two hundred and eighty-five proximal margins and 286 distal margins were reviewed, and the incidence of infiltration was related to the length of...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198212001-00012
更新日期:1982-12-01 00:00:00