Abstract:
BACKGROUND:Hilar resection, especially in combination with liver resection, results in substantial morbidity and mortality, which clearly influences the overall outcome. In the present study, patients who underwent resection of a proximal bile duct tumor were analyzed with the aim of identifying risk factors for morbidity and mortality. METHODS:Between 1983 and 1998, 112 consecutive patients underwent a local resection, which in 32 patients was combined with a hemihepatectomy (11 extended resections). Eighty-four percent of the patients underwent preoperative (endoscopic) drainage. For evaluation of different treatment strategies during the study, the period was divided in three 5-year intervals. RESULTS:Postoperative complications occurred in 65% of the patients. The overall hospital mortality was 15% for local resections and 25% for hemi-hepatectomies. There was a significantly lower morbidity and no mortality after hilar resection during the last 5 years. A higher Bismuth classification showed significant correlation with postoperative morbidity. Extended liver resections and vascular resections and a preoperative albumin level below 35 g/L were found to be significant predictors of increased mortality in univariate analysis. CONCLUSIONS:The overall morbidity and mortality rate in this series is higher than most recently published series. More (extended) liver resections resulted in an increased rate of microscopic tumor-free resections, at the cost of higher hospital morbidity and mortality. Improved preoperative work-ups will result in a selection of patients who might benefit from these extensive resections.
journal_name
Surgeryjournal_title
Surgeryauthors
Gerhards MF,van Gulik TM,de Wit LT,Obertop H,Gouma DJdoi
10.1067/msy.2000.104250subject
Has Abstractpub_date
2000-04-01 00:00:00pages
395-404issue
4eissn
0039-6060issn
1532-7361pii
S0039606000312132journal_volume
127pub_type
杂志文章相关文献
SURGERY文献大全abstract:OBJECTIVE:We determined whether hepatic intra-arterial infusion of 5-fluorouracil (5-FU) in patients with synchronous hepatic metastases from colorectal cancer, in whom the primary lesion was resectable but hepatic metastatic lesions were non-resectable helped improve survival time when administered on the basis of the...
journal_title:Surgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.surg.2006.03.001
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:The management of large thyroid nodules remains unclear. Ultrasonography is a central tool in the assessment of thyroid nodules, yet its role in risk stratification of large thyroid nodules has been studied only seldomly. OBJECTIVE:The aim of this study was to determine the utility of ultrasonography in cha...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.06.011
更新日期:2019-12-01 00:00:00
abstract::Cholecystectomy will not always relieve the abdominal symptoms of the patient with gallstones. The functional effects of gallbladder removal in a patient with a patent cystic duct are not known in detail. Studies of the function of the gallbladder and pancreas have suggested feedback mechanisms for the release of chol...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1987-02-01 00:00:00
abstract:BACKGROUND:In clinically node-negative patients with differentiated thyroid cancer (DTC), indications for routine central lymph node dissection (RCLD) are the subject of intensive research, and surgeons are divided between the pros and cons of this surgery. To better define the role of neck dissection in the treatment ...
journal_title:Surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.surg.2014.02.010
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:In trauma patients a specific pattern of the hormone endocrine response to injury has been described. Conflicting data exist regarding the hormonal changes during sepsis. We studied the time course and variability of the hormonal and metabolic responses to severe sepsis in twelve medical patients. METHODS:H...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1993-11-01 00:00:00
abstract::Pancreatic polypeptide (PP) deficiency has been associated with impaired hepatic sensitivity to insulin and pancreatogenic diabetes in chronic pancreatitis. Since pancreatic resection might also result in PP deficiency, hepatic responses to insulin infusion (0.25 mU/kg/min) were determined by the euglycemic glucose cl...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1988-08-01 00:00:00
abstract:BACKGROUND:Prolonged warm ischemic injury in non-heart-beating donors (NHBDs) significantly affects hepatic allograft function after liver transplantation (LTx). METHODS:The effects of FK506 and the platelet activating factor antagonist E5880 on postoperative function of hepatic allografts procured from NHBDs were eva...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1998-06-01 00:00:00
abstract:BACKGROUND:Transplantation of pancreatic islets is an effective treatment for select patients with type 1 diabetes. Improved cellular therapy results may be realized by altering the gene expression profile of transplanted islets. Current viral and nonviral vectors used to introduce nucleic acids for gene regulation hol...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2010.05.013
更新日期:2010-08-01 00:00:00
abstract:PURPOSE:We have developed a novel molecular method of diagnosis using the technique of transcriptase-reverse transcriptase concerted reaction (TRC) for the detection of cancer micrometastasis. This study prospectively examined the clinical importance of the TRC diagnosis with peritoneal lavage fluids collected from gas...
journal_title:Surgery
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/j.surg.2013.10.004
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:We wished to determine the role and significance of preoperative chemotherapy and radiotherapy in management of operable cancer of the esophagus. METHODS:Twenty-two patients with clinical stage I-II cancer of the esophagus were entered in a prospective study of preoperative chemotherapy (5-fluorouracil/cisp...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:We previously developed an intraoperative 10-point Surgical Apgar Score-based on blood loss, lowest heart rate, and lowest mean arterial pressure-to predict major complications after colorectal resection. However, because complications often arise after uncomplicated hospitalizations, we sought to evaluate w...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2010.01.015
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND:The incidence of reoperation for adhesive bowel obstruction after general abdominal surgery is 2.5% and carries a considerable risk of mortality and morbidity. Adhesions account for 56% of all cases of bowel obstruction. Most epidemiologic knowledge regarding adhesive bowel obstruction is derived from data o...
journal_title:Surgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.surg.2015.11.016
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine if systemic acidosis induced by peritoneal absorption of carbon dioxide (CO2 ) during laparoscopy plays a role in CO2 pneumoperitoneum-mediated attenuation of the acute phase inflammatory response associated with perioperative sepsis. The influence of hepatic polymo...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2005.01.005
更新日期:2005-05-01 00:00:00
abstract:BACKGROUND:Current isolation techniques recover only 20% to 50% of the pancreatic islets. Brain death (BD) is characterized by activation of proinflammatory cytokines (PICs) with reduced islet yields and functionality. We previously reported that 17beta-estradiol (E2) induces cytoprotection to human islets exposed to P...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2004.05.009
更新日期:2004-08-01 00:00:00
abstract:BACKGROUND:Osteopontin acts thru myeloid zinc finger-1 and transforming growth factor-β to drive the adoption of a cancer-associated fibroblast phenotype by local mesenchymal stem cells. Cancer-associated fibroblasts increase cancer cell stemness. METHODS:Mesenchymal stem cells were exposed to osteopontin or were cocu...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.05.042
更新日期:2019-10-01 00:00:00
abstract::During the past 3 years (June, 1974, to July, 1977), 51 patients underwent reoperation for persistent or recurrent hyperparathyroidism at the Mayo Clinica. The overall success rate for cervical reoperation was 72% and for mediastinal reoperation, was 64%. Arteriography alone provided accurate preoperative localization...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1978-09-01 00:00:00
abstract:BACKGROUND:Carotid endarterectomy (CEA) reduces the risk of stroke in selected patients with symptomatic and asymptomatic carotid disease, but its beneficial influence on cognitive performance in the elderly remains debatable. This prospective study sought to determine early and long-term neurocognitive outcomes after ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2011.06.031
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:In primary hyperparathyroidism, successful parathyroidectomy leads to improved bone mineral density in the majority of cases. Our aim was to further explore the relationship between hypercalciuria, kidney function, and bone recovery after parathyroidectomy. METHODS:Bone mineral density, estimated glomerular...
journal_title:Surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.surg.2017.02.017
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine performance retention after initial and ongoing Fundamentals of Laparoscopic Surgery (FLS) skills training. METHODS:Surgery residents (postgraduate year [PGY] 1-5; n = 91) initially underwent proficiency-based training during a 2-month period for all 5 FLS tasks. S...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2009.05.009
更新日期:2009-08-01 00:00:00
abstract::We will describe the development of new resectional techniques with the use of the ultrasonic scalpel in 33 patients with liver disease. Our experience is presented in the performance of anatomic and nonanatomic liver resections by use of this device. Its saline-cooled tip vibrated at ultrasonic frequencies and select...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1984-02-01 00:00:00
abstract:BACKGROUND:Ventral incisional hernia is the most common long-term complication after an abdominal operation. Among newly diagnosed colorectal cancer patients, we screened the preoperative plasma proteome to explore predictive markers for the development of an incisional hernia. METHODS:We utilized preoperative plasma ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2016.08.025
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Surgical management of patients with metastatic or recurrent rectal cancer remains controversial. Self-expanding metal stents are increasingly used for palliative treatment of advanced tumors, although long-term results are not yet available. METHODS:Between 1996 and 2003, 521 patients underwent surgery for...
journal_title:Surgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.surg.2004.05.043
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Evidence indicates that sentinel node (SN) biopsy can accurately predict axillary nodal status. Debate exists as to the optimal method of SN identification. METHODS:Patients with clinical T1 or T2 tumors and negative axillae were randomized to SN localization with blue dye (B) alone (n = 50) or blue dye plu...
journal_title:Surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1999-10-01 00:00:00
abstract:BACKGROUND:Lateral neck lymph node (LN) metastases (N1b) have been identified as independent risk factors of recurrence in patients with papillary thyroid carcinoma (PTC). OBJECTIVE:This study aimed to determine the predictive factors of recurrence in N1b PTC patients and to clarify the postoperative event patterns. ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2015.08.033
更新日期:2016-03-01 00:00:00
abstract::Surgical education has been exposed to increasing challenges as students have moved from the highly structured environment of a university hospital into a variety of clinical settings within the community. Presented with a general surgical service that uses ten relatively autonomous teaching services in seven hospital...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1976-07-01 00:00:00
abstract::With advances in clinical immunosuppression, results in organ transplantation continue to improve. During a 52-month period, 507 cadaver renal transplants were performed, including 435 primary and 72 nonprimary transplants. All patients were managed with quadruple immunosuppression (prednisone, azathioprine, sequentia...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1988-10-01 00:00:00
abstract:BACKGROUND:Lung injury in severe acute pancreatitis is mediated by infiltrating leukocytes. Our laboratory has previously demonstrated that acute lung injury in acute pancreatitis results in an up-regulation of vascular adhesion molecule-1 (VCAM-1) cell surface receptor expression on pulmonary vascular endothelium and ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2003.84
更新日期:2003-02-01 00:00:00
abstract:BACKGROUND:Necrotizing enterocolitis is the leading case of gastrointestinal-related morbidity in premature infants. Necrotizing enterocolitis totalis is an aggressive form of necrotizing enterocolitis, which has traditionally been managed with comfort care. Recent advances in management of short bowel syndrome have re...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.03.005
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to examine the mortality rate of penetrating cardiac trauma in a large urban hospital. METHODS:This was a retrospective study over a period of 5 years and 5 months of all patients admitted alive with a stab or a gunshot cardiac injury. RESULTS:There were 310 patients with a st...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00
abstract::The recent surge in enthusiasm for laparoscopic surgery has created concern that abdominal insufflation with carbon dioxide produces a respiratory acidosis. This may be because of both transperitoneal gas absorption and impaired ventilation with increased dead space from elevated intraabdominal pressure. To examine th...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1993-05-01 00:00:00