Surgical treatment of stage IV colorectal cancer with synchronous liver metastases: A systematic review and network meta-analysis

Until prospective comparative trials are available, the treatment approach in patients with stage IV CRC with SCRLM should be discussed in a multidisciplinary team and tailored to the oncological, technical, and clinical characteristics of each patient

Expanding clinical indications of mechanically isolated stromal vascular fraction : a systematic review

Background: Mechanically isolated stromal vascular fraction (tSVF, tissue SVF) is a potent regenerative solution, increasingly used as a therapeutic modality for a variety of pathologies. With recent evidence conclusively favoring mechanical isolation over enzymatic alternatives, the therapeutic share and indications of tSVF are expected to grow even further. Objectives: The aim of this study was to provide a systematic review of all studies reporting on the use of tSVF. Methods: A systematic search was undertaken of the Embase, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials databases. Outcome measures included clinical indications, such as recipient area, adverse events, clinical results recipient area, method of application, follow-up duration and evaluation methods. Results: Of the total of 4505 articles identified, 186 full-texts were screened. Thirty-four studies, reporting on 1443 patients were included. tSVF-based therapy was observed for 10 different pathologies, including aged skin (8 studies), scars (5), wounds (6), osteoarthritis (6), tendinopathy (2), temporomandibular joint disorders (1), androgenic alopecia (1), perianal fistula (3), migraine (1), and vocal fold scarring (1). Across all studies, tSVF-based therapy resulted in favorable clinical results. Overall, 50 (3.43%) minor and one (0.07%) major adverse events were observed, mainly related to the liposuction procedure. Conclusions: tSVF offers a safe, easy and legal treatment modality for a range of indications. Future research is indicated to identify the optimal isolation protocol, dose and timing. In addition, basic research remains crucial to identify the mechanism of action of SVF within different pathologies

Pure laparoscopic formal right hepatectomy versus anatomical posterosuperior segmental resections: a comparative study

Background: To analyze the differences in perioperative outcomes between laparoscopic formal right hepatectomies (RH) and laparoscopic anatomical posterosuperior (PS) resections, including segmentectomies in PS segment SVII and right posterior sectionectomies (segment VI and VII resection). Methods: A retrospective analysis of all patients undergoing laparoscopic formal RHs and anatomical PS resections, including segmentectomies in PS segment SVII and right posterior sectionectomies (segment VI and VII resection), between January 2010 and August 2017 was performed. The two groups were compared in terms of patients’ characteristics, intraoperative parameters, and short-term outcomes. Results: Sixty-eight patients were included of which 32 RHs and 36 anatomical PS resections. In the PS resection group, 18 had a segmentectomy of segment VII and 18 had a bisegmentectomy of both segments VI and VII. Patients’ preoperative data were comparable. The lesion size was higher in the RHs (P<0.001). A significant shorter operative time was found in the PS group: 280 [230–315] vs. 357 [300–463] min in the RH group (P<0.001). Blood loss was comparable: 520 [390–906] in the RHs vs. 560 [370–1,030] in the PS group (P=0.595). The overall morbidity rate was comparable being 25% in the RHs and 22.2% in the PS group (P=1.000). A longer length of stay (LOS) {7 [5–8] vs. 5 [4–7] days, P=0.012} and higher readmission rate (12.5% vs. 0%, P=0.044) was observed in the RHs compared to the PS cohort. Concerning surgical margins, the R0 rate was comparable in the two groups; 90.9% in the RHs vs. 95.2% in the PS group (P=1.000). Conclusions: When deemed feasible based on lesion position and size, the laparoscopic parenchyma-preserving approach using anatomical PS segmental resections is associated with shorter hospital stay and a lower readmission rate in respect to formal RH. Overall, short-term surgical parameters indicated that both procedures are safe and feasible in experienced hands, however both demand a great deal of technical expertise