Abstract:
OBJECTIVE:To assess the survival benefit of additional resection of an intraoperative positive proximal bile duct margin (BD(Marg)) in patients undergoing hepatectomy for hilar cholangiocarcinoma (HCCA). SUMMARY BACKGROUND DATA:Intraoperative evidence of invasive cancer at the proximal (BD(Marg)) is associated with a dismal survival irrespective of whether a final negative (BD(Marg)) is achieved with an additional resection. METHODS:Clinicopathologic, operative, and survival data of consecutive patients undergone curative intent hepatectomy with bile duct resection (n = 75) for HCC (1989-2010) were analyzed. RESULTS:Frozen-section examination of the proximal (BD(Marg)) revealed invasive cancer in 19 of the 67 patients. After additional resection, which was possible in 18 cases, a secondary R0 (BD(Marg)) resection was achieved in 15 patients (83.3%), with 2 of these having, at final pathology, positive radial and distal margins. Eventually, 8 patients were classified as R1 and 67 as R0 (54 primary R0 and 13 secondary R0). Median survival of patients who had a secondary R0 resection (30.6 months) was similar to that of primarily R0-resected patients (29.3 months) and significantly better than that of R1 patients (14.9 months) (P = 0.026). Median time to recurrence and site of recurrence were similar in R0 patients independently of the performance of an additional resection. The incidence of biliary fistula was significantly increased (44.4% vs 17.5%; P = 0.02) in patients necessitating a margin re-resection. CONCLUSIONS:Additional resection of a positive proximal (BD(Marg)) , albeit associated with an increased risk of biliary fistula, offers a significant survival benefit and should be attempted whenever possible.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Ribero D,Amisano M,Lo Tesoriere R,Rosso S,Ferrero A,Capussotti Ldoi
10.1097/SLA.0b013e3182368f85subject
Has Abstractpub_date
2011-11-01 00:00:00pages
776-81; discussion 781-3issue
5eissn
0003-4932issn
1528-1140pii
00000658-201111000-00014journal_volume
254pub_type
杂志文章abstract::The aim of this study was to determine the long-term outcome among 390 patients with ulcerative colitis who underwent ileal J pouch-anal anastomosis and whether patient or operative factors influenced results. The combined operative morbidity rate for the pouch-anal anastomosis and the subsequent closure of the tempor...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198710000-00011
更新日期:1987-10-01 00:00:00
abstract::Sixty patients with chronic alcohol-induced pancreatitis with endoscopic retrograde cholangiopancreatography evidence of common bile duct stenosis were studied to determine the clinical spectrum and natural history of this complication, as well as the indications for biliary bypass. In 17% of patients, common bile duc...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198911000-00007
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVE:We assessed circulating tumor cells (CTCs) with epithelial and mesenchymal phenotypes as a potential prognostic biomarker for patients with pancreatic adenocarcinoma (PDAC). BACKGROUND:PDAC is the fourth leading cause of cancer death in the United States. There is an urgent need to develop biomarkers that pr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001600
更新日期:2016-12-01 00:00:00
abstract::Hypermetabolism characterizes the metabolic response to thermal injury and the extent of energy production is positively related to the rate of urinary catecholamine excretion. Alpha and beta adrenergic blockade decreased metabolism from 69.6 +/- 5.3 Kcal/m(2)/hr to 57.4 +/- 5.2 (p < 0.01), and infusion of 6 microgm e...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197410000-00031
更新日期:1974-10-01 00:00:00
abstract:OBJECTIVE:To explore challenges and opportunities for surgery departments' academic missions as they become increasingly affiliated with expanding health systems. SUMMARY BACKGROUND DATA:Academic medicine is in the midst of unprecedented change. In addition to facing intense competition, narrower margins, and decrease...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004462
更新日期:2020-11-12 00:00:00
abstract:OBJECTIVE:To assess the feasibility, safety, and outcome of laparoscopic liver resection for malignant liver tumors. SUMMARY BACKGROUND DATA:The precise role of laparoscopy in resection of liver malignancies (hepatocellular carcinoma [HCC] and liver metastases) remains controversial despite an increasing number of pub...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/00000658-200207000-00014
更新日期:2002-07-01 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 determine whether the acute anti-inflammatory influence of epinephrine (EPI) extends to changes in heart rate variability (HRV) induced by the prototypical inflammatory stimulus, endotoxin (lipopolysaccharide [LPS]). SUMMARY BACKGROUND DATA:HRV reflects fluctuating cardiac autonomic inputs and is acutely ...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e3181a40193
更新日期:2009-05-01 00:00:00
abstract::Transplantation of the intrathoracic inferior vena cava into the abdominal inferior vena cava of the recipient was performed in inbred rat strains of the following combinations: Syngeneic F344 leads to F344, RT-1-identical allogeneic LEW leads to F344, and RT-1-different allogeneic CAP leads to F344. In the RT-1-diffe...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198103000-00006
更新日期:1981-03-01 00:00:00
abstract::A prospective study was performed on 358 patients to examine the diagnosis, management, and natural history of fish bone ingestion. All patients admitted with the complaint had a thorough oral examination. Flexible endoscopy under local pharyngeal anesthesia would be performed on patients with negative findings. Of 11...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199004000-00012
更新日期:1990-04-01 00:00:00
abstract::Middle aortic syndrome typically occurs as severe hypertension in young patients who have weak or absent femoral pulses and an abdominal bruit. It results from a diffuse narrowing of the distal thoracic and abdominal aorta, commonly involving the visceral and renal arteries. The clinical presentation, angiographic ass...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198609000-00012
更新日期:1986-09-01 00:00:00
abstract::Two patients with aortic abdominal aneurysms in association with horseshoe kidney are presented, making a total of 34 cases recorded in the literature. In 29 patients, the aneurysm was resected and five patients were non-resectable. Because of the abnormalities in vascular supply to the abnormal kidney, it is importan...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197503000-00015
更新日期:1975-03-01 00:00:00
abstract:BACKGROUND:Liver resection is performed for many types of malignancies. Few reports document actual long-term survival. METHODS:Long-term follow-up of a series of 548 liver resections performed between 1970 and 1992 was performed and is presented. RESULTS:All patients were followed for at least 15 years after surgery...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181b59491
更新日期:2009-12-01 00:00:00
abstract::A prospective randomized trial was conducted comparing the effect of three antibiotics: cefamandole (CM), cefazolin (CZ), and vancomycin (V), used as prophylaxis for prosthetic valve surgery, on the prothrombin (PT) response to warfarin (W) on the third day of anticoagulant therapy. Twenty patients, with normal preope...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-198708000-00007
更新日期:1987-08-01 00:00:00
abstract::The prognostic and postoperative monitoring capabilities of the CEA assay were compared to pathological staging of the operative specimens, clinical followup including endoscopy, radiology and scanning techniques, as well as DNCB skin testing and laboratory enzyme determinations (alkaline phosphatase and transaminase)...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197601000-00002
更新日期:1976-01-01 00:00:00
abstract:OBJECTIVE AND BACKGROUND:Our objective was to determine the fetal in vivo microRNA signature in hypoplastic lungs of human fetuses with severe isolated congenital diaphragmatic hernia (CDH) and changes in tracheal and amniotic fluid of fetuses undergoing fetoscopic endoluminal tracheal occlusion (FETO) to reverse sever...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001054
更新日期:2015-12-01 00:00:00
abstract::One hundred sixty-three patients undergoing reoperative parathyroidectomy were evaluated before and after operation to determine the incidence of, risk factors for, and morbidity of vocal cord paralysis. These patients were compared to 77 patients undergoing initial parathyroid operation, only one of whom had vocal co...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198603000-00011
更新日期:1986-03-01 00:00:00
abstract::Population based surgical rates for various common surgical procedures were analyzed on a regional basis by examining select uniform hospital discharge abstract data from Wisconsin hospitals. The surgical asbracts of nearly 64,000 procedures were compared to the supply of physicians and showed a significant variation ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197802000-00012
更新日期:1978-02-01 00:00:00
abstract:BACKGROUND:The role for neoadjuvant systemic therapy in resectable pancreas adenocarcinoma remains undefined. OBJECTIVE:We evaluated the efficacy of gemcitabine and oxaliplatin administered as preoperative therapy in patients with resectable pancreas adenocarcinoma. METHODS:Eligible patients were screened using compu...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000000251
更新日期:2014-07-01 00:00:00
abstract::Thrombotic thrombocytopenic purpura (TTP) is a disease process characterized by microangiopathic anemia, fever, neurologic manifestations, renal abnormalities, and thrombocytopenia. These clinical findings are caused by vascular occlusions of the microcirculation. At present the utilization of splenectomy, in the trea...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197811000-00021
更新日期:1978-11-01 00:00:00
abstract::The effects of gastrectomy and vagotomy on pancreatic glucagon release were investigated clinically. The study included 20 men and eight women, who ranged in age from 28 to 69 years, and who were divided into the following four groups: 1) patients with gastroduodenal ulcers treated with partial gastrectomy, by the Bil...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198107000-00005
更新日期:1981-07-01 00:00:00
abstract::Intestinal ischemia-reperfusion is a common clinical event associated with both clinical and experimental distant organ injury. In particular, the pulmonary microvasculature appears to be susceptible to injury resulting from systemic inflammatory mediator activation. This study was designed to evaluate the hypothesis ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199301000-00009
更新日期:1993-01-01 00:00:00
abstract::Stress ulcer has become an important clinical entity and its two major complications--bleeding and perforation--are among the most baffling problems, in terms of management, in clinical practice. Perforation, though the less common of the two, is perhaps the most formidable particularly when this occurs in a very sick...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197912000-00006
更新日期:1979-12-01 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:Venous thromboembolic events (VTE) are potentially preventable causes of morbidity and mortality after injury. We hypothesized that the current clinical incidence of VTE is relatively low and that VTE risk factors could be identified. METHODS:We queried the ACS National Trauma Data Bank for episodes of deep ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000137138.40116.6c
更新日期:2004-09-01 00:00:00
abstract::Fifteen patients who had a prior portasystemic shunt underwent orthotopic liver transplantation. Shunt types were portacaval in six patients, H-graft mesocaval in six, distal splenorenal in two, and proximal splenorenal in one. Mean blood loss and hospital stay were highest in the portacaval group. Retransplants (two ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198901000-00008
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:The authors present an accurate and comprehensive snapshot of appendicitis and the practice of appendectomy in the 1990s. METHODS:Appendectomies were performed on 4950 patients in 147 Department of Defense hospitals worldwide over a 12-month period ending January 31, 1993. RESULTS:The median age was 23 year...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199703000-00003
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVE:Marked variations in sentinel lymph node dissection (SLND) technique have been identified, and definitive qualifications for SLND performance remain controversial. Based on previous reports and expert opinion, we predicted that 20 to 30 cases of SLND with axillary lymph node dissection (ALND) would enable sur...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/01.sla.0000184210.68646.77
更新日期:2005-10-01 00:00:00
abstract::A new approach for preventing and treating sepsis due to central venous catheter (CVC) has been devised at the Istituto Nazionale Tumori of Milan. A prospective protocol has been developed that includes the weekly exchange of the CVC via a guidewire as well as its exchange when a CVC-related sepsis is suspected. Growt...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-198307000-00009
更新日期:1983-07-01 00:00:00
abstract:OBJECTIVE:To evaluate both institutional and individual learning curves with focused abdominal ultrasound for trauma (FAST) by analyzing the incidence of diagnostic inaccuracies as a function of examiner experience for a group of trauma surgeons performing the study in the setting of an urban level I trauma center. SU...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200005000-00009
更新日期:2000-05-01 00:00:00