2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI

Surgical Treatment of Colon Cancer of the Splenic Flexure: A Systematic Review and Meta-analysis

This is a systematic review and meta-analysis on the surgical treatments of splenic flexure carcinomas (SFCs). Medline, EMBASE, and Scopus were searched from January 1990 to May 2016. Studies of at least 5 patients comparing extended right colectomy (ERC) versus left colectomy (LC) and/or laparoscopy versus open surgery for SFCs were retrieved and analyzed. Overall, 12 retrospective studies were selected, including 569 patients. ERC was performed in 23.2% of patients, whereas LC in 76.8%. Pooled data suggested that ERC and LC had similar oncologic quality of resection and postoperative outcomes. Laparoscopy was used in 50.6% of patients (conversion rate: 2.5%) and it was associated with significantly shorter time to oral diet, fewer postoperative complications, and shorter hospital stay than open surgery. In conclusion, the optimal extent of SFC surgical resection, that is, ERC or LC remains under debate. However, laparoscopy provides better postoperative outcomes and fewer postoperative complications than open surgery

Laparoscopic vs. open surgery for T4 colon cancer: A propensity score analysis

The study aimed to compare, using propensity score matching (PSM) analyses, the short- and long-term results of laparoscopic colectomy (LC) versus open colectomy (OC) in a bicentric cohort of patients with T4 colon cancer

Minimally invasive surgery versus percutaneous radio frequency ablation for the treatment of single small (≤3 cm) hepatocellular carcinoma: a case-control study

Patients with single small hepatocellular carcinoma (HCC) can be managed by surgical resection or radio frequency ablation (RFA), with similar recurrence and survival rates. Recently, minimally invasive surgery (MIS) has been introduced in liver surgery, and the advantage/drawback balance between surgery and RFA needs reassessment

Comparison of Different Nodal Staging in Patients With Locally Advanced Mid-low Rectal Cancer After Long-term Neoadjuvant Chemoradiation Therapy

The aim of this study was to compare the ability of different lymph nodal staging systems to predict cancer recurrence in a multicenter European series of patients who underwent proctectomy after neoadjuvant chemoradiotherapy for locally advanced rectal cancer

Predicting Difficult Laparoscopic Total Mesorectal Excision for Locally-advanced Mid-low Rectal Cancer: The EuMaRCS Score Validation

BACKGROUND/AIM: The European MRI and Rectal Cancer Surgery (EuMaRCS) score was proposed to identify preoperatively difficult laparoscopic total mesorectal excision (L-TME) for locally advanced rectal cancer (LARC). This study aimed to test EuMaRCS's validity. PATIENTS AND METHODS: Data were retrieved from a European multicenter database, including patients with mid/low LARC, treated with neoadjuvant chemoradiation therapy and L-TME with primary anastomosis. The EuMaRCS score was calculated on: BMI>30 (3 points), interspinous distance3 being associated with the best balance in sensitivity (82.6%) and specificity (66.1%). CONCLUSION: The EuMaRCS score represents a validated tool to predict preoperatively difficult L-TME in LARC patients

Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis

The surgical resection of the splenic flexure carcinoma (SFC) is challenging and the optimal surgical procedure for SFCs remains a matter of debate. The present study aimed to compare in a multicenter European sample of patients the short- and long-term outcomes of extended right (ERC) vs. left (LC) vs. segmental left colectomy (SLC) for SFCs

Laparoscopic major hepatectomy for hepatocellular carcinoma in elderly patients: a multicentric propensity score\u2011based analysis

Considering the increase in overall life expectancy and the rising incidence of hepatocellular carcinoma (HCC), more elderly patients are considered for hepatic resection. Traditionally, major hepatectomy has not been proposed to the elderly due to severe comorbidities. Indeed, only a few case series are reported in the literature. The present study aimed to compare short-term and long-term outcomes between laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients with HCC using propensity score matching (PSM)

Laparoscopic major hepatectomy for hepatocellular carcinoma in elderly patients: a multicentric propensity score\u2011based analysis

Considering the increase in overall life expectancy and the rising incidence of hepatocellular carcinoma (HCC), more elderly patients are considered for hepatic resection. Traditionally, major hepatectomy has not been proposed to the elderly due to severe comorbidities. Indeed, only a few case series are reported in the literature. The present study aimed to compare short-term and long-term outcomes between laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients with HCC using propensity score matching (PSM)

Liver transplantation for hepatocellular carcinoma after successful treatment of macrovascular invasion

Macrovascular invasion is considered a contraindication to liver transplantation for hepatocellular carcinoma (HCC) due to a high risk of recurrence. The aim of the present multicenter study was to explore the outcome of HCC patients transplanted after a complete radiological regression of the vascular invasion by loco-regional therapies, and define sub-groups with better outcomes. Medical records of 45 patients were retrospectively reviewed and imaging was centrally assessed by an expert liver radiologist. In the 30 patients with validated diagnosis of macrovascular invasion, overall survival was 60% at 5 years. Pre-transplant alpha fetoprotein (AFP) value was significantly different between patients with and without recurrence (p=0.019) and the optimal AFP cut-off was 10ng/ml (area under curve= 0.78). Recurrence rate was 11% in patients with pre-transplant AFP <10ng/ml. The number of viable nodules (p=0.008), the presence of residual HCC (p=0.036) and satellite nodules (p=0.001) on the explant were also significantly different between patients with and without recurrence. Selected HCC patients with radiological signs of vascular invasion could be considered for transplantation, provided that they previously underwent successful treatment of the macrovascular invasion resulting in a pre-transplant AFP <10ng/ml. Their expected risk of post-transplant HCC recurrence is 11%, and further prospective validation is needed