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RISS 인기검색어
- 검색키워드
- 저자 : ( Tarun Piplani ) (검색결과 2 건)
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( Deeksha Kapoor ),( Tarun Piplani ),( Azhar Perwaiz ),( Amanjeet Singh ),( Adarsh Chaudhary ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Studies suggest that loss of muscle mass possibly contributes to increased post-operative morbidity following pancreaticoduodenectomy( PD).The extent and exact effect of low muscle mass has however not been clearly elucidated. We are sharing, possibly the first study from India, assessing the impact of radiologically demonstrable muscle loss in patients undergoing PD for pancreatic and periampullary tumours. Methods: A prospective study was conducted from May 2016 to November 2019 in patients undergoing PD for pancreatic and periampullary tumours in the Department of G.I. Surgery, Medanta - The Medicity, Gurugram, Haryana, India, which is a high volume centre, performing ~ 77 PDs (range 72 - 83) per year. Pre-operative abdomen computerised scan was used to calculate psoas muscle area. Low muscle mass was defined as values less than 10th percentile of a normal cohort (data collected from prospective organ donors). Post-operative data was collected for each patient. Results: Out of 271 patients undergoing PD, pre-operative radiological images were available for 192 patients on PACS (Picture archiving and communication system), of which, 40.8% were found to have low muscle mass. The incidence of delayed gastric emptying (52.1% vs 41.9%, p - 0.270) and clinically relevant post op pancreatic fistula (20.8% vs 17.6%, p value - 0.652) was not statistically different between the two groups. The length of stay, readmission rate and mortality were unaffected by loss of muscle mass. Conclusions: Though low muscle mass has traditionally been shown to predict outcomes following PD, it’s contribution, however, may be mitigated by the surgery being performed at high volume
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( Rohan Jagat Chaudhary ),( V. Sagar Puppala ),( Thiagarajan S. ),( Prashant Bhangui ),( Amit Rastogi ),( Tarun Piplani ),( S. Baijal ),( V. Vohra ),( Arvinder Singh Soin ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: To study the outcomes of our algorithmic-approach for safe optimisation and surgical planning in patients with Hilar- Block. Methods: Retrospective-analysis of prospectively-maintained database of patients undergoing surgery for hilar-block from Jan2013-May2019 was done.Our approach includes Imaging, Biliary-decompression, Future-liver-remnant-Volume(FLR)augmentation based on CT-Volumetry and FLR-function assessment. Results: 45cases of hilar-blocks underwent resections.32were Hilar-cholangiocarcinoma,5-Intrahepatic-cholangiocarcinoma, 6-Ca-Gall-Bladder with hilar-block,2-IgG4-sclerosing- cholangitis-presenting as malignant-masquerade. The mean age was57±12years and 30(67%) were males. On MRCP, hilar-blocks types 2,3a,3b,4 were 3,15,17,10 respectively. Pre-operative biliary-decompression of FLR were done in 21cases[19 PTBD(Percutaneous-Transhepatic-biliary-drainage)/ 2 EBD(Endoscopic-biliary-drainage)]. Additional PTBD were done in 2 cases for inadequate fall in SB, and 3 for cholangitis. The mean SB(Serum-Total-Bilirubin) at presentation was 9.57±5.58mg/dl. The rate of fall of S.bilirubin was faster in patients < 50yrs of age and type-3 hilar-blocks than in type-4 hilar- blocks. PVE was performed in 14cases and FLR hypertrophy of 11.3± 3.03%was achieved.The quality of FLR was assessed with LAI(n=39),fibroscan(n=17), ICGR15(n=12), HVPG (n=35), and selective-remnant-biopsy(n=14,if HVPG >10 mm Hg,ICGR15> 15%, or in-suspected steatosis or fibrosis).After optimization, surgical procedures done were Right-Hepatectomy(7), Right-TriSectorectomy(7), Extended-Right-Hepatectomy(9), Left-Hepatectomy(6),Extended-Left-Hepatectomy(5), Left-Trisectorectomy( 8) and Bile-duct-excision-alone(3).Eleven patients required concomitant vascular-resections and reconstructions(- 8portal-vein-resections, 2 hepatic-arterial-resection,1both) to obtain R0. R0 and R1 resections were achieved in 42(93%) and 3 patients. Clavien-Dindo-Grade3/4 complications were 22.2%(n=10). 8(18%)patients had Post-Hepatectomy-Liver- Failure.Overall operative-mortality was 5/45(11.1%). Conclusions: Our algorithmic approach for safe optimization by preoperative-biliary-drainage, FLR-augmentation and FLR-functional- assessment have led to a high rate of R0 major liver resection and good outcomes in patients with hilar-blocks.Augmentation of FLR can also increase resectability in borderline resectable cases.
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