Laparoscopic extended liver resection: are postoperative outcomes different?

Background: Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their outcomes are limited. The aim of this study was to compare the perioperative characteristics and postoperative outcomes of LEMH to standard LMH. Methods: All patients who underwent purely laparoscopic anatomical right or left hepatectomy and right or left trisectionectomy between February 1998 and January 2016 are enrolled. Demographic, clinicopathological, and perioperative factors were collected prospectively and analyzed retrospectively. Perioperative characteristics and postoperative outcomes in LEMH were compared to those of standard LMH. Results: Among 195 patients with LMH, 47 (24.1%) underwent LEMH, colorectal liver metastases representing 66.7% of all indications. Preoperative portal vein embolization was undertaken in 31 (15.9%) patients. Despite more frequent vascular clamping, blood loss was higher in LEMH group (400 vs. 214 ml; p = 0.006). However, there was no difference in intraoperative transfusion requirements. Thirty-one patients experienced liver failure with no differences between LMH and LEMH groups. Postoperative mortality was comparable in the two groups [3 (2.5%) LMH patients vs. 2 (5%) LEMH patients (p = 0.388)]. Overall morbidity was higher in the LEMH group [49 LMH patients (41.5%) vs. 24 LEMH patients (60%) (p = 0.052)]. Patients treated with left LEMH experienced more biliary leakage (p = 0.011) and more major pulmonary complications (p = 0.015) than left LMH. Conclusion: LEMH is feasible at the price of important morbidity, with manageable and acceptable outcomes. These exigent procedures require high-volume centers with experienced surgeons

JOURNAL OF CLINICAL ONCOLOGY Volume: 37 Issue: 15 Supplement: S Meeting Abstract: 4136 Published: MAY 20 2019

International audienc

Evaluation of a micro-spectrometer for the real-time assessment of liver graft with mild-to-moderate macrosteatosis: A proof of concept study

BACKGROUND & AIMS: Liver macrosteatosis (MS) is a major predictor of graft dysfunction after transplantation. However, frozen section techniques to quantify steatosis are often unavailable in the context of procurements, and the findings of preoperative imaging techniques correlate poorly with those of permanent sections, so that the surgeon is ultimately responsible for the decision. Our aim was to assess the accuracy of a non-invasive pocket-sized micro-spectrometer (PSM) for the real-time estimation of MS. METHODS: We prospectively evaluated a commercial PSM by scanning the liver capsule. A double pathological quantification of MS was performed on permanent sections. Initial calibration (training cohort) was performed on 35 livers (MS\textless/=60%) and an algorithm was created to correlate the estimated (PSM) and known (pathological) MS values. A second assessment (validation cohort) was then performed on 154 grafts. RESULTS: Our algorithm achieved a coefficient of determination R2=0.81. Its validation on the second cohort demonstrated a Lin's concordance coefficient of 0.78. Accuracy reached 0.91%, with reproducibility of 86.3%. The sensitivity, specificity, positive and negative predictive values for MS \textgreater/=30% were 66.7%, 100%, 100% and 98%, respectively. The PSM could predict the absence (\textless30%)/presence (\textgreater/=30%) of MS with a kappa coefficient of 0.79. Neither graft weight nor height, donor body mass index nor the CT-scan liver-to-spleen attenuation ratio could accurately predict MS. CONCLUSION: We demonstrated that a PSM can reliably and reproducibly assess mild-to-moderate MS. Its low cost and the immediacy of results may offer considerable added-value decision support for surgeons. This tool could avoid the detrimental and prolonged ischaemia caused by the pathological examination of (potentially) marginal grafts. This device now needs to be assessed in the context of a large-scale multicentre study. LAY SUMMARY: Macro-vacuolar liver steatosis is a major prognostic factor for outcomes after liver transplantation. However, it is often difficult for logistical reasons to get this estimation during procurement. Therefore, we developed an algorithm for a commercial, portable and affordable spectrometer to accurately estimate this content in a real-time fashion. This device could be of great interest for clinical decision-making to accept or discard a potential human liver graft

Possibility of inclusion of the Sobibór Forests into Importand Birds Areas and Special Protection Areas networks

One of the greatest challenges of nature conservation is to identify and locate networks of protected areas, which will preserve the biodiversity. The paper aims to show the ornithological value of the Sobibór Forests (E Poland) and to emphasize the fact that the network of Important Bird Areas (IBA) and Special Protection Areas within Natura 2000 (SPA) may require additions. The study was conducted in the period of 2008−2016, mainly on forested areas occupying 256 km2. The Sobibór Forests are characterized by a large diversity of habitats, but are mainly covered by Scots pine Pinus sylvestris. High diversity of wetlands and marshlands make the Sobibór Forest unique within the country. Three methodologies were used to estimate population size of chosen species: sampling, census and random observations. 31 species from Annex I of the Birds Directive plus 25 species of SPEC or non−SPECE category were observed which allows to consider this area as one of the most valuable for avifauna in Poland. Six breeding species classify the Sobibór Forests as the IBA and SPA. These species include Black Stork Ciconia nigra (8−13 breeding pairs), Common Crane Grus grus (80−120 breeding pairs), Grey Great Owl Strix nebulosa (0−7 breeding pairs i.e. 50−100% of Polish breeding population), Eagle Owl Bubo bubo (6 breeding pairs), White−backed Woodpecker Dendrocopos leucotos (40−70 breeding pairs) and Grey−headed Woodpecker Picus canus (20−40 breeding pairs). Six other species show potential for qualification, but not enough data has been collected yet. The list of this specie includes: Short−toed Snake Eagle Circaetus gallicus, Common Snipe Gallinago gallinago, Stock Dove Columba oenas, European Nightjar Caprimulgus europaeus, Collared Flycatcher Ficedula albicollis and Bluethroat Luscinia svecica. The Sobibór Forests occupy a small area compared to other IBA forests. However, the number of breeding species classifies the surveyed area as 7th among other IBAs. Moreover all eligible species may be considered as a bioindicators of the natural state of the forest. This is proof of the high natural value of this area