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Acceptable Outcomes (acceptable + outcome)

Distribution by Scientific Domains
Medical Sciences100%
Distribution within Medical Sciences
Surgery & Surgical Specialties40%

Selected Abstracts

Novel approach to laparoscopic resection of tumours of the distal pancreas

ANZ JOURNAL OF SURGERY, Issue 4 2009
Soumen Das De
Abstract Background:, Laparoscopic resection for small lesions of the pancreas has recently gained popularity. We report our initial experience with a new approach to laparoscopic spleen-preserving distal pancreatectomy so that the maximum amount of normal pancreas can be preserved while ensuring adequate resection margins and preservation of the spleen and splenic vessels. Methods:, Three patients underwent laparoscopic distal pancreatectomy with spleen and splenic vessel preservation over a 2-month period. Surgical techniques and patient outcomes were examined. Results:, All three patients were females, with ages ranging from 31 to 47 years. Two patients underwent resection using the conventional medial-to-lateral dissection as the lesion was close to the body or proximal tail of the pancreas. The third patient had a lesion in the distal tail of the pancreas and surgery was carried out in a lateral-to-medial manner. This new approach minimized excessive sacrifice of normal pancreatic tissue for such distally located lesions. The splenic artery and vein were preserved in all cases and there was no significant difference in clinical outcome, operative time or intraoperative blood loss. Conclusion:, Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels is a feasible surgical technique with acceptable outcome. We have shown that a tailored approach to dissection and pancreatic transection based on the location of the lesion allows the maximum amount of normal pancreatic tissue to be preserved without additional morbidity. Although the conventional ,medial-to-lateral' approach is recommended for more proximal tumours of the pancreas, distal lesions can be safely addressed using the ,lateral-to-medial' approach. [source]

Current status of minimally invasive necrosectomy for post-inflammatory pancreatic necrosis

HPB, Issue 2 2009
Benoy Idicula Babu
Abstract Objective:, This paper reviews current knowledge on minimally invasive pancreatic necrosectomy. Background:, Blunt (non-anatomical) debridement of necrotic tissue at laparotomy is the standard method of treatment of infected post-inflammatory pancreatic necrosis. Recognition that laparotomy may add to morbidity by increasing postoperative organ dysfunction has led to the development of alternative, minimally invasive methods for debridement. This study reports the status of minimally invasive necrosectomy by different approaches. Methods:, Searches of MEDLINE and EMBASE for the period 1996,2008 were undertaken. Only studies with original data and information on outcome were included. This produced a final population of 28 studies reporting on 344 patients undergoing minimally invasive necrosectomy, with a median (range) number of patients per study of nine (1,53). Procedures were categorized as retroperitoneal, endoscopic or laparoscopic. Results:, A total of 141 patients underwent retroperitoneal necrosectomy, of whom 58 (41%) had complications and 18 (13%) required laparotomy. There were 22 (16%) deaths. Overall, 157 patients underwent endoscopic necrosectomy; major complications were reported in 31 (20%) and death in seven (5%). Laparoscopic necrosectomy was carried out in 46 patients, of whom five (11%) required laparotomy and three (7%) died. Conclusions:, Minimally invasive necrosectomy is technically feasible and a body of evidence now suggests that acceptable outcomes can be achieved. There are no comparisons of results, either with open surgery or among different minimally invasive techniques. [source]

Current controversies surrounding liver transplantation for hepatocellular carcinoma

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2010
Mauricio F Silva
Abstract Liver transplantation (LT) for hepatocellular carcinoma (HCC) has progressed rapidly over the last decade from a futile therapy to the first choice therapy for suitable patients. Excellent outcomes of LT for HCC can be largely attributed to the use of the Milan Criteria, which have restricted LT to patients with early stage tumors. These criteria may be conservative, and it is likely that a subset of patients with tumors beyond these criteria can have acceptable outcomes. However, there is currently insufficient data to accept more liberal criteria as a standard of care, and a higher quality evidence base must be achieved to prevent poor utilization of valuable donor liver resources. In the future, it is probable that more sophisticated selection criteria will emerge incorporating aspects of tumor biology beyond tumor size and number. Dropout from the waiting list due to tumor progression remains a clinical challenge particularly in regions with prolonged waiting times. Priority allocation using HCC MELD points is a practical and transparent solution that has successfully reduced waitlist dropout for HCC patients. Further refinements of the HCC MELD point system are required to ensure equity of access to LT for non-HCC patients and prioritization of HCC patients with the highest risk of dropout. Improving the evidence base for pre-LT locoregional therapy to prevent waitlist dropout is an urgent and difficult challenge for the LT community. In the interim transplant clinicians must restrict the use of these therapies to those patients who are most likely to benefit from them. [source]

AASLD/ILTS transplant course: Is there an extended donor suitable for everyone?

LIVER TRANSPLANTATION, Issue S2 2005
Andrew Cameron
Key Points 1The clinical success of liver transplantation coupled with the current era of organ shortage has caused many centers to expand their criteria for acceptable donors. 2The definition of "Extended Criteria Donor" (ECD) is becoming better understood and quantified. 3Recipient factors that portend poor outcome must be recognized and factored in as well. Grafts and recipients must be "matched" to manage and minimize the risk from ECDs. 4Maintaining acceptable outcomes as ECD concepts evolve is paramount. 5Absolute risk factors for poor graft function still exist and must be respected, but relative risk factors are now well identified, quantified, accepted, and managed as an alternative to high waiting list mortality. (Liver Transpl 2005;11:S2,S5.) [source]

Kidney Transplantation Using Elderly Non-Heart-Beating Donors: A Single-Center Experience

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5p1 2006
M. G. J. Snoeijs
Although acceptable outcomes have been reported in both non-heart-beating (NHB) and elderly donors individually, the large pool of elderly NHB donors has not yet been fully utilized. In 1994, we expanded our transplant protocol to include NHB donors aged over 65 years and this study compares the clinical outcomes with regular NHB transplantations. Up to June 2005, 24 patients were transplanted at our center with kidneys from NHB donors aged 65 years or more, whereas 176 patients received grafts from conventional NHB donors during the same period. Grafts from older donors were associated with inferior glomerular filtration rates (29 vs. 44 mL/min after 1 year, p = 0.01) and graft survival (52% vs. 68% after 5 years, p = 0.19) compared to younger NHB donor grafts, although the difference in graft survival was not statistically significant. Exclusion of older NHB donor kidneys with severe vascular pathology resulted in similar graft survival of older and younger NHB donor kidneys. We conclude that the use of elderly NHB donors in order to expand the donor pool was associated with unacceptable clinical outcomes and cannot be justified without further refinement in their selection, for example, by histological assessment of pretransplant biopsies. [source]